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THE  LIBRARY 

OF 

THE  UNIVERSITY 

OF  CALIFORNIA 

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DENTAL  MEDICINE 

GORGAS 


Standard  Books  on  Dentistry 


BROOMELL.  Anatomy  and  Histology  of  the  Human 
Mouth  and  Teeth.  By  Dr,  I.  Norman  Broomell, 
Professor  of  Anatomy,  Dental  Histology,  and  Pros- 
thetic Technics  in  the  Pennsylvania  College  of  Dental 
Surgery,  Philadelphia.  Handsomely  illustrated  with 
284  engravings.     Large  octavo.     Cloth,  net,  $4.50. 

HARRIS.  Principles  and  Practice  of  Dentistry. 
Thirteenth  Edition.  Including  Anatomy,  Physiology, 
Pathology,  Therapeutics,  Dental  Surgery,  and  Mech- 
anism. By  the  late  Chapin  A.  Harris,  M.  D., 
D.  D.  S.  Edited  and  Thoroughly  Revised  by  Fer- 
dinand J.  S.  Gorgas,  a.  M.,  M.  D.,  D.  D.  S.,  Pro- 
fessor of  the  Principles  of  Dental  Science,  Dental 
Surgery,  and  Prosthetic  Dentistry  in  the  University 
of  Maryland.  1250  Illustrations.  11 80  pages.  8vo. 
Cloth,  net,  ^6.00;  Leather,  net,  ;^7.oo. 

HARRIS.  Dictionary  of  Dentistry.  Sixth  Edition, 
Revised.  Including  Definitions  of  such  Words  and 
Phrases  of  the  Collateral  Sciences  as  Pertain  to  the 
Art  and  Practice  of  Dentistry.  By  the  late  Chapin 
a.  Harris,  M.  D.,  D.  D.  S.  Rewritten,  Revised, 
and  Enlarged  by  Ferdinand  J.  S.  Gorgas,  M.  D., 
D.  D.  S.,  Professor  of  Principles  of  Dental  Science, 
Dental  Surgery,  and  Prosthetic  Dentistry  in  the 
University  of  Maryland.     Octavo. 

Cloth,  net,  ^5.00;  Leather,  net,  ;^6.oo. 

RICHARDSON'S  Mechanical  Dentistry.  Seventh 
Edition.  By  Joseph  Richardson,  D.  D.  S.  Thor- 
oughly Revised  and  Enlarged  by  George  W.  War- 
ren, A,  M.,  D.  D.  S.,  Professor  of  Clinical  Den- 
tistry and  Oral  Surgery,  Pennsylvania  College  of 
Dental  Surgery,  Philadelphia.     691  lUus.     8vo. 

Cloth,  net,  ^5.00;  Leather,  net,  «6.oo. 


P.  BLAKISTON'S  SON  &  CO. 

Publishers,   Philadelphia 


DENTAL  MEDICINE 


A  MANUAL 


OF 


Dental  Materia  Medica 

AND  THERAPEUTICS 


BV 

FERDINAND  J.  S.  GORGAS,  A.  M.,  M.  D.,  D.  D.  S. 

Editor  of  "Harris^  Principles  and  Practice  of  Dentistry"  and  "Harris"  Diction- 
ary of  Medical  Terminology  and  Dental  Surgery,"  Author  of  "  Questions 
and  Answers  for  Dental  Students,"  Professor  of  the  Principles 
of  Dental  Science,   Oral  Surgery,  etc.,  in  the 
University  of  Maryland,   Baltimore 


SEVENTH  EDITION.     REVISED  AND  ENLARGED 


PHILADELPHIA 
P.  BLAKISTON'S  SON  &  CO 

IOI2  WALNUT  STREET 
1901 


Entered,  according  to  Act  of  Congress,  in  the  year  1901,  by 

P.  BLAKISTON'S  SON  &  CO. 

In  the  Office  of  the  Librarian  of  Congress,  at  Washington,  D.  C. 


lU      ^ 


Preface  to  Seventh  Edition. 


In  presenting  the  Seventh  Edition  of  the  "  Dental  Medicine," 
the  author  entertains  the  hope  that  his  labors  have  resulted  in 
such  an  improvement  of  this  work  as  to  render  the  present  edi- 
tion more  valuable  than  the  one  that  preceded  it. 

The  success  which  has  attended  the  issue  of  the  different 
editions  has  been  very  gratifying,  and  its  popularity  has  been 
shown  by  the  short  time  which  has  elapsed  between  them. 

The  number  of  opportunities  thus  offered  to  revise  its  editions 
have  been  taken  advantage  of  to  increase  its  usefulness  as  a  text- 
book for  dental  students,  and  also  as  a  reference  book  for  dental 
practitioners. 

The  advance  of  Dental  Materia  Medica  and  Therapeutics  has 
been  such  as  to  render  it  necessary  to  increase  the  size  of  this 
work  in  every  revision,  in  order  that  it  may  fulfil  the  object  of 
its  preparation  ;  hence,  among  the  remedial  agents,  and  combina- 
tions of  such  agents  which  have  been  added  to  the  present  edi- 
tion are  the  following  :  Vapocaine,  Chloretone,  Enzymol,  Eu- 
formal,  Phenalgin,  Airol,  Actol,  Glucide,  Glutol,  Orthoform, 
Caffein,  Digitalis,  Sozoiodol,  Liquid  Air,  Nitrous  Oxide  and 
Oxygen,  Nitrous  Oxide  and  Atmospheric  Air,  Pressure  Anaes- 
thesia by  compressed  Air,  Sulpho-Carbolate  of  Zinc,  Silver  Sul- 
pho-Carbolate,  Anestile,  The  Treatment  of  Dental  Caries  with 
Nitrate  of  Silver,  The  Hypodermic  Syringe,  etc.,  etc.  A  new 
Table  of  Doses  of  Medicinal  Agents  has  been  substituted  for  the 
one  in  former  editions. 

Important  additions  have  been  made  to  manv  articles  such  as 
those   on    Inflammation,   Diagnosis    and    Treatment   of   Mouth 

9 


10  PREFACE   TO  SEVENTH   EDITION. 

Affections,  embracing  Abscess,  Ulceration,  Caries  and  Necrosis 
of  Bone,  Gangrene,  Septicemia,  Pyemia,  Opening  Abscesses, 
Erosion  of  Teeth,  Stomatitis,  Sterilizing  Instruments,  Adminis- 
tering Anaesthetic  Agents,  both  Local  and  General ;  together 
with  important  additions,  including  recent  investigations  on  the 
physiological  and  medicinal  actions  and  properties,  and  Thera- 
peutic and  Dental  Uses  of  many  of  the  remedies,  including 
anaesthetics,  before  noticed  in  this  work. 

Ferdinand  J.  S.  Gorgas. 
Hamilton  Terrace,  Baltimore,  Md, 


Preface  to  Sixth  Edition. 


In  preparing  the  Sixth  Edition  of  the  "  Dental  Medicine,"  the 
author  has  conscientiously  endeavored  to  further  improve  a  trea- 
tise which  has  become  a  text-book  for  the  dental  student,  and  a 
work  of  reference  for  the  dental  practitioner. 

It  has  been  his  aim  not  only  to  make  additions  to  the  present 
volume,  but  also  to  so  improve  it  as  to  render  it  worthy  of  a 
continuance  of  the  favor  heretofore  so  generously  bestowed  upon 
those  which  have  preceded  it. 

The  general  arrangement  of  this  new  edition  is  the  same  as  in 
the  previous  one,  and  all  parts  have  been  carefully  revised  and 
corrected. 

A  work  of  this  character  should,  as  far  as  is  possible,  be  a  com- 
plete, as  well  as  a  practical  exposition  of  the  source  or  derivation, 
properties  and  methods  of  application  or  administration,  and  also 
the  uses  of  the  various  drugs  now  employed  in  dental  practice. 

And,  as  cases  often  occur  in  the  treatment  of  which  old  and 
familiar  remedies  are  employed  in  vain,  it  is  well  that  we  should 
possess  a  knowledge  of  other  and  more  recent  ones  to  the  use  of 
which  we  mav  successfully  resort.  A  number  of  drugs  and 
combinations  have  been  recently  introduced,  some  of  which 
appear  to  be  verv  valuable  additions  to  the  dental  materia  medica; 
and  it  has  been  the  aim  of  the  author  to  bring  the  description 
and  application  of  such  drugs  as  are  useful  up  to  the  date  of  pub- 
lication of  this  new  edition.  As  a  general  rule,  such  information 
has  only  appeared  in  domestic  and  foreign  journals,  which  are  often 
practically  inaccessible  ;  hence,  the  necessity  for  a  work  on  dental 

11 


12  PREFACE  TO  SIXTH  EDITION. 

medicine,  and  its  frequent  revision  in  order  to  meet  the  advance 
of  this  branch  of  dental  science. 

Important  additions  have  been  made  to  the  text,  a  new  chapter 
on  Cataphoresis  has  been  inserted,  and  among  the  new  remedies 
which  have  been  added  are :  Eucaine,  Borolyptol,  Ammonol, 
Euthymol,  Formaline,  Glyco-Thymoline,  Pasteurine,  Sanitol, 
etc.,  etc. 

Ferdinand  J.  S.  Gorgas. 
Hamilton  Terrace,  Baltimore,  Md. 


Preface  to  the  First  Edition. 


This  work  has  been  prepared  by  the  author  In  deference  to 
many  requests  from  former  pupils,  and  has  been  compiled  from 
lectures  delivered  by  him  in  dental  institutions  during  the  past 
twenty-five  years,  and  notes  obtained  from  the  standard  works 
on  Materia  Medica  and  Therapeutics,  and  also  from  personal 
experience  as  a  dental  practitioner  and  teacher. 

While  the  author  claims  the  credit  of  the  compilation,  he  does 
not  claim  originality  in  the  sources,  derivations,  medical  proper- 
ties and  action  of  the  various  articles  of  dental  materia  medica 
which  are  given  in  this  work. 

His  intention  has  been  to  present  not  alone  his  own  ideas  as 
to  the  particular  application  of  remedies,  but  also  those  of  well- 
known  and  acknowledged  authorities,  and  in  such  a  manner  as 
may  be  of  service  to  the  dental  student  in  acquiring  a  knowledge 
of  this  important  branch  of  his  profession;  hence  nothing  has 
been  presented  in  this  work  that,  in  the  author's  opinion,  is  not 
applicable  to  dental  practice,  and  that  will  not  be  of  benefit  to 
the  dental  student. 

The  dental  formulary  comprises  many  valuable  combinations, 
and  credit  has  been  given,  in  every  case  where  it  was  possible, 
to  the  authors  of  the  different  preparations. 

The  necessity  for  an  American  work  of  this  kind  has  long 
been  apparent,  and  after  years  of  delay  and  promises  the  author 
gratefully  dedicates  this  work  to  his  former  pupils  in  the  dental 
institutions  with  which  he  has  been  and  is  now  connected,  in  the 
capacity  of  a  teacher. 

Ferdinand  J.  S.  Gorgas. 

Hamilton  Terrace,  Baltimore,  Md. 

13 


CONTENTS. 


PAGE 

Prefaces  ........        5-9 

Definition  of  Subjects              ......  17 

Action  of  Medicinal  Substances    ......  17 

Tables  for  preparing  Percentage  Solutions  and  Rule  .  .  .20,  22 

Abbreviations,  with  Latin  and  English  Terms     ....  22 

Approximate  Measurements    ......  24 

Measuring  Liquids  by  Drops         ......  25 

Fineness  of  Powder    .......  25 

Weights  and  Measures      .             .             .             .             ...  26 

Metric  or  French  Decimal  System  of  Weights  and  Measures              .  27 
Table  of  Equivalents         .             .             .             .             .             .             .29 

Rules  for  Regulating  Doses     ......  30 

Topical  Remedies              .......  32 

The  Endermic  Method            ......  32 

The  Hypodermic  Method              .             .              ....  32 

Counter-irritants          .......  ^^ 

Setons  and  Issues               .......  34 

General  Bloodletting               ......  34 

Local  Bloodletting  by  Leeching,  Cupping  and  Scarifications         .             .  34 

Electricity  as  a  Therapeutic  Means  in  the  Treatment  of  Disease       .  35 

Incompatibility      ........  41 

Table  of  Doses  of  all  Officinal  Medicines,  Expressed  in  Terms  of  both 
the  Apothecaries'  and  the  Decimal  Metric  System  of  Weights  and 

Measures           .......  43 

Poisons — Symptoms  and  Antidotes            .....  61 

The  Pulse        ........  68 

Pulsation  per  Minute  at  Various  Ages       .             .             •             .             .  69 

Respiration  at  Various  Ages  .             .             .             .             .             ,  71 

Thermometers       .  .  .  .  .  .  .  .71 

Temperature  ........  72 

Table  of  Elementary  Substances                .....  73 

15 


16 


CONTENTS. 


PAGE 
74 

77 

78 

78 

108 

III 


Table  of  the  Solubility  of  Chemicals  in  Water  and  Alcohol 

Natural  Distribution  of  Remedies  ..... 

Classification  of  Medical  Substances  ..... 

Definitions  of  the  Various  Classes  of  Medicinal  Agents  . 

Forms  in  which  Medicinal  Substances  are  employed  . 

Inflammation,  with  Special  Reference  to  Oral  Mucous  Membrane 

Important  Points  in  Diagnosing  Affections  of  the  Mouth,  with  a  Synop- 
sis of  Treatment  ...... 

Characteristic  Indications  of  the  Tongue  .... 

Source,  Derivation,  Medical  Properties  and  Action,  and  Therapeutic 
Uses  of  Medicinal  Substances  Employed  in  Dental  Practice  ;  To- 
gether with  their  Dental  Uses  and  Application 

Administration  of  General  Anaesthetic  Agents      .... 

The  Dangers  of  Anaesthesia    ...... 

Preventive  Measures  Against  the  Dangers  of  Anaesthesia 

Treatment  of  Dangerous  Symptoms  of  Anaesthesia    . 

Methods  of  Resuscitation — Sylvester's  Method— Hall's  Ready  Method    262,  263 
"  "  Howard's  Method,  etc.  .  .  .         264 


187 


190 

255 
261 
261 
261 


Local  Anaesthesia        .  .  .  .  . 

Pressure  Anaesthesia  by  Compressed  Air  . 

Liquid  Air  as  an  Anaesthetic 

Rapid  Breathing  as  a  Pain  Obtunder 

Combination  of  Nitrous  Oxide  and  Oxygen   . 

"  Nitrous  Oxide  and  Atmospheric  Air 

Antiseptics  in  Dental  Practice  , 

Cataphoresis  ..... 

Periods  for  the  Eruption  of  the  Teeth 
Authorities  Consulted        .... 
Index  to  Dental  Formulary  and  Dental  Diseases 
General  Index       ..... 


266 
269 
269 
271 
478 
478 
581 
591 
596 

599 
600 
609 


DENTAL  MEDICINE. 


DEFINITION  OF  SUBJECTS. 


Materia  Medica  is  that  branch  of  medical  science  which  refers 
to  and  describes  the  methods  and  substances  known  as  "  medici- 
nal agents,"  which  are  employed  in  the  prevention  and  treatment 
of  disease ;  also  their  source  or  derivation,  preparation,  composi- 
tion, and  properties. 

Therapeutics  is  that  branch  of  medical  science  which  comprises 
the  doctrine  of  the  management  of  disease.  Generally,  however, 
the  term  is  restricted  to  a  description  of  the  modus  operandi  of 
medicines,  or,  in  other  words,  their  use,  application,  effects,  and 
doses,  when  applied  in  the  treatment  of  various  morbid  condi- 
tions. 

Pharmacology  is  the  science  of  the  action  of  medicines,  and  is 
expressed  by  what  is  termed  their  "  physiological  action." 

Pharmacy  is  the  art  of  preparing  medicines,  and  dispensing 
them  by  direction  of  the  therapeutist. 

An  accurate  knowledge  of  the  principles  and  rules  which 
govern  the  administration  and  action  of  medicinal  substances 
enables  the  practitioner  to  restore  disordered  functions,  and  to  so 
impress  the  organism  as  to  maintain  harmonious  conditions,  by 
means  of  which  the  various  functions,  in  a  state  of  health,  are 
intimately  connected  by  relation  and  sympathy. 

Some  medicinal  agents  exert  their  influence  on  primary  nour- 
ishment, converting  food,  by  digestion,  into  the  substance  of 
organic  beings,  while  other  remedies,  without  interfering  with 
digestion,  by  a  modification  of  the  process  of  assimilation  exert 
2  17 


18  DENTAL  MEDICINE. 


a  destructive  influence  upon  the  tissues.  Some  medicinal  agents 
afFcct  the  nervous  system,  and  others  are  so  irritant  in  their  effect^ 
as  to  cause  their  speedy  expulsion  ;  while  others,  again,  have  a 
particular  affinity  for  certain  organs,  and  are  eliminated  by  them, 
the  effect  ceasing  as  soon  as  the  evacuation  is  completed.  Other 
medicinal  agents  prevent  septic  decomposition,  and  the  growth 
of  micro-organisms. 

What  are  known  as  topical  or  external  remedies  act  directly 
upon  the  parts  to  which  they  are  applied,  and  their  general  effects 
are  produced  through  the  nervous  system. 

The  methods  of  treatment  which  have  for  their  objects  the 
prevention,  and  relief  of  pain,  and  the  cure  of  disease,  include 
preventive  or  prophylactic  treatment,  which  embraces  all  hvgienic 
conditions  which  will  obviate  any  tendencv  to  disease,  prevent  its 
extending  to  others,  and  the  employment  of  antiseptic  agents ; 
for  example,  in  dental  practice  attention  to  the  hygiene  of  the 
oral  cavity,  which  consists  in  keeping  the  teeth  and  associate 
parts  clean,  and  preventing  dental  caries,  and  affections  of  the 
oral  mucous  membrane  :  also  palliative  treatment,  which  affords 
relief  from  pain,  such  as  that  of  odontalgia,  neuralgia  of  dental 
origin,  etc.;  also  curative  treatment,  which  eradicates  the  disease 
completely ;  for  example,  in  dental  practice  the  proper  prepara- 
tion and  filling  of  carious  cavities,  the  cure  of  alveolar  abscesses, 
alveolar  pyorrhoea,  etc. 

The  indications  for  treatment  will  depend  upon  the  nature  and 
location  of  the  affection,  and  the  symptoms  present.  The  con- 
dition of  vital  organs,  such  as  the  heart,  lungs,  and  kidneys,  also 
influences  the  treatment ;  for  example,  in  the  administration  of 
anzesthetics. 

Medicines  enter  the  circulation  by  either  external  application  or 
internal  administration.  Externally  by  such  methods  as  the  epi- 
dermic^ or  by  inunction— the  application  of  medicines  to  the  skin 
by  rubbing  or  friction ;  the  en-epidermic^ — the  application  of  plas- 
ters, poultices,  lotions,  etc.,  to  the  skin  ;  the  endermic^ — the  appli- 
cation of  a  blister,  which  is  followed  by  that  of  a  medicine  to 
the  raw  surface  thus  produced  ;  the  hypodermic^ — the  injection  of 
medicines  into  the  skin  and  mucous  membrane  to  obtain  a  more 


DEFINITION  OF  SUBJECTS.  19 

rapid  effect  than  when  administered  by  the  mouth  internally. 
Internally,  by  the  mouth  ;  by  inhalation ;  by  the  rectum^  when  it  is 
inadvisible  to  administer  them  by  the  mouth. 

The  changes  which  medicines  undergo  when  taken  into  the 
system  depend  upon  the  condition  of  the  system,  the  temperature 
of  the  body,  the  food  and  drink,  and  the  tendency  of  medicines 
to  combine  with  other  substances  and  form  different  compounds. 
The  rapidity  with  which  medicines  enter  the  circulating  fluid  is 
governeJ  by  their  composition.  The  crystalloid  substances  pass 
into  the  blood  very  readily,  while  colloid  substances  enter  slowly, 
or  not  at  all.  Arsenious  acid  is  an  example  of  the  crystalloid. 
Corrosive  poisons  not  only  destroy  life,  but  also  the  parts  with 
which  they  come  in  contact,  while  other  poisons  destroy  life 
alone.  The  blood  conveys  medicines  to  different  parts  of  the 
body,  and  during  such  a  passage  they  change  the  character  and 
composition  of  the  blood  ;  and  are  eliminated  from  the  system 
bv  the  excretory  organs,  such  as  the  lungs,  kidneys,  skin,  urinary 
and  salivary  organs.  The  form  in  which  medicines  are  adminis- 
tered and  applied,  also  modify  their  effects. 

The  action  of  drugs  is  also  modified  by  pharmaceutical  combi- 
nation, as  the  joint  effect  of  two  medicines  is  different  from  that 
one  of  them  may  cause,  for  opium  given  with  mercury  will  pre- 
vent the  purgative  action  of  the  mercury.  The  action  of  medi- 
cines may  be  direct  so  as  to  produce  local  effects ;  or  it  may  be 
general  or  indirect  when  the  entire  body,  or  remote  organs  are 
affected.  A  large  number  of  medicines  operate  physically  on  the 
bodv  and  affect  remote  parts  through  the  agency  of  the  nervous 
svstem ;  among  such  are  electricity,  cold,  heat,  mechanical  irri- 
tants, etc.,  which  affect  remote  parts  by  the  influence  of  the 
cerebro-spinal  and  ganglionic  systems.  The  afferent  or  sensory 
nerves  convey  impressions  to  the  nerve-centre,  and  the  efferent 
or  motor  nerves  transmit  impressions  from  the  centre  to  muscles, 
vessels,  glands,  etc.,  and  the  effects  of  medicines  are  transmitted 
to  the  brain,  producing  an  excitement  of  a  nerve-centre  and  a 
reflex  action  is  carried  along  the  efferent  nerves,  producing  cer- 
tain symptoms.  The  effects  of  medicines  are  modified  by  the 
age  of  the   patient,  as  young  children  require  small  doses  as  a 


20  DENTAL  MEDICINE. 


general  rule ;  by  the  sex,  as  females  possess  greater  susceptibility 
of  the  nervous  system,  and  more  excitability  of  the  vascular 
system  than  males ;  they  have  also  less  energy,  and  medicines  act 
on  them  more  powerfully  and  rapidly  and  for  a  less  period  than 
on  males ;  also  climate  influences  the  effects  of  medicines,  as 
some,  such  as  narcotics  for  example,  act  more  energetically  in 
hot  climates,  and  others  less  energetically,  calomel  for  example  y 
habit  also  influences  the  action  of  medicines,  as  some  become 
inert  after  long  continued  use ;  also  diseased  conditions  modify 
the  effects  of  medicines,  such  as  mercury  in  fevers ;  the  idiosyn- 
crasy also,  as  is  shown  by  the  effects  manifested  in  different  indi- 
viduals ;  mercury  for  example  will  cause  profuse  salivation  in 
susceptible  patients  when  a  very  small  quantity  is  adminis- 
tered ;  also  the  mind,  as  the  cheerful  convalesce  sooner  than  the 
despondent. 

Some  medicines  have  a  specific  action  on  certain  tissues  and 
organs  of  the  body, — as  alcohol  on  the  brain,  strychnine  on  the 
spinal  cord. 

Temperaments  are  peculiarities  of  organization  characterizing 
the  different  classes  of  individuals,  the  nervous  patient  being  more 
easily  affected  by  medicinal,  than  he  is  by  other  agencies,  while 
the  phlegmatic  patient  is  not. 

Idiosyncrasies  are  peculiarities  belonging  to  single  individuals, 
and  they  are  so  numerous  that  a  knowledge  of  them  is  important 
for  the  practitioner. 

TABLES  FOR  PREPARING  PERCENTAGE  SOLUTIONS. 

The  following  tables  of  Dr.  Sherrard,  Ph.  C,  are  simple  and 
require  but  little  explanation.  The  first  table  gives  percentage 
solutions,  as,  for  instance,  4  per  cent,  cocaine  muriate  solution  ; 
the  second  table  gives  parts  in  1,000  or  5,000,  as,  for  instance, 
corrosive  sublimate  i  in  1,000.  The  use  of  the  first  table  is  as 
follows:  Run  down  column  i  until  the  correct  percentage 
wanted  is  found,  then  move  to  the  right  along  the  line  until  the 
column  is  found  giving  the  amount  of  the  fluid  measure  to  be 
made  up;  at  the  intersection  will  be  found  the  weight  of  the  salt 
required.     For  example,  suppose   it   is  desired  to  make  4  fl.  oz. 


TABLES  FOR  PERCENTAGE  SOLUTIONS. 


21 


of  4  per  cent,  cocaine  muriate  solution,  run  down  the  left-hand 
column  to  4,  then  along  to  the  right  till  the  column  headed  4  fl. 
oz.  is  reached.  At  the  intersection  of  the  two  will  be  found 
72912,  and  this  is  the  number  of  grains  needed.  It  must  be  re- 
membered that  this  is  the  amount  of  water-  to  take,  and  not  q.  s. 
water  to  make  the  volume,  and  also  that  these  tables  are  true 
only  for  water,  and  not  for  alcohol,  or  any  other  fluid.  The 
second  table  is  similarly  employed.  If  other  amounts  of  a  solu- 
tion are  required  than  those  given  in  the  tables,  a  simple  mathe- 
matical calculation  will  determine  the  amount  of  drug  or  salt  re- 
quired for  a  specified  amount  of  solution.  For  example,  if  8 
fluid  ounces  of  a  four  per  cent,  solution  is  required,  follow  down 
the  4  fluid  ounce  column  until  opposite  4  per  cent.  ;  the  number 
of  grains  required  are  72912.  Now,  to  make  8  fluid  ounces, 
just  twice  as  much  (145,824  grs.)  is  required.  For  all  dispensing 
and  administering  purposes  in  any  prescribed  doses,  the  figures 
thus  given  are  correct.  It  is  therefore  clear  that  if  a  drachm  of 
a  2  per  cent,  solution  be  prescribed,  exactly  2  per  cent,  of  that 
drachm  is  the  salt  in  the  solution,  the  other  98  per  cent,  being 
the  water. 

FOR   MAKING   ANY    QUANTITY   OF   PERCENTAGE   SOLUTIONS. 


^ 

^ 

«.- 

^ 

i« 

.  >«.. 

^ 

i  0 -• 

0  u  ta 

°  «  s 

i5  0^ 

0  lU  d 

0  u  rt 

0    D    d 

0    4,    tS 

«-^" 

.   S   in 

^■^z 

^■^.z 

-    t«    U 

"  ■«   0 

N   -    0 

ro-2   0 

Tf-     0 

u^-   0 

0—0 

VO  *-    0 

.-    u    M 

r;    I,    M 

_=    ^    <2J0 

-    I.   M 

r-     U     M 

^    i-    M 

^  I.  ao 

r  eac 
wate 
e  dru 

r  eacl 
wate 
e  dru 

r  eac! 
watei 
e  dru 

r  eacl 
wate 
e  dru 

r  eacl 
wate 
e  dru 

r  eacl 
wate 
e  dru 

read 
wate 
e  dru 

.°  •——. 

0  t_  j= 

,Oc-  ^ 

,0  v_-fi 

o^ji 

Ou-  -s 

.Oi^-fi 

j-i  0         *i  0  "" 

fe    0  - 

tn^  - 

fe  0  - 

pH^  - 

t**  0  ■" 

To  make 

Grains.    Grains. 

Grains.    Grains.    Grains. 

Grains. 

Grains. 

I  per  cent.  . 

4.557       9.114'     13.671'     18.228     22.785 

45-57 

72.912 

2  per  cent.  . 

9. 114     18.228     27.342'    36.456     45-570 

91.14 

145.824 

3  per  cent.  . 

13.671 

27.352!    41-013     54-684     68.355 

1367 1 

218.416 

4  per  cent.  . 

18.228 

36.456     54.684     72.912     91.14 

182.28 

291.648 

5  per  cent.  . 

22.785 

45-57   1    68.355     91.14     113-925 

227.85 

364-56 

10  per  cent.  . 

45-57 

91.14     136.71      182.28     227.85 

455-7 

729.12 

15  percent.  . 

68.355'  136-71     205.065  273.42     341.775 

683-55 

1093.68 

20  per  cent.  . 

91.14  1  182.28     273.42     364.56     45570 

911.4 

1458.24 

25  per  cent.  . 

113.925  227.85  341775. 45570 :  569-625 

"39-25 

1822.80 

40  per  cent.  . 

182.28  364.56  546.84 1729.12  911.4 

1822.8 

2916.48 

DENTAL  MEDICINE. 


FOR   MAKING   ANY   QUANTITY   OF   SOLUTION    WHEN   STATED    IN    PARTS   PER 
THOUSAND,   HUNDRED,    ETC. 


1    .u. 

.«- 

.i^ 

.  >>. 

•  Vu 

.  u- 

.  t^ 

fl.  oz 
ike   0 
r  salt. 

fl.  ozs 
ake   0 
r  salt. 

fl.  ozs 
ake   0 
r  salt. 

fl.  ozs 
ake  0 
ir  salt. 

fl.  OZS 

ake  0 
r  salt. 

>  fl.  OZS 

ake  0 
r  salt. 

S  0  ^ 

-.    rt    *- 

-  ii  0 

N  -    0 

r<T^   C 

n--  0 

ir,-  0 

u  —   0 

vo  i2  0 

^    u   M 

j:  >-  M 

.r:   u  W) 

•^  ir,  ^ 

x:  ^  ^ 

.£  ^  S" 

(1    <U    3 

0   0)    s 

0    U    3 

0    1)    3 

0  <"  3 

0  u   3 

•Sua 

c4   u    u 

M  -^    ^ 

(4   -"    ^ 

M  ■n  >- 

r?    -^     ^ 

y  ♦-  V- 

y  *-  ;. 

)_    ^    u 

2  g-B 

u   ^   <u 

I.    >    V 

£   rt-O 

u    ^    V 

u  ^  « 

TO    rt  t3 
u.    !*    U 

0  ^x: 

.0  t^  ,a 

,0  i_  J= 

,0  w-  J= 

o^js 

0,^  J5 

Ov^  ^ 

(IH     0- 

fe"^- 

fe    0- 

PH     0    - 

fxn'B*- 

Ph    0  - 

pL,     0    - 

To  make  a  so- 
lution of 

Grains. 

Grains. 

Grains. 

Grains. 

Grains. 

Grains. 

Grains. 

I  in  looo  .    . 

•4557 

.9114 

1.367 1 

1.8228 

2.278 

4  557 

7.291 

1  in  500 

.9114 

1.8228 

2.7312 

3-6456 

4.557 

9. 114 

14.582; 

I  in  400 

1139 

2.278 

3-4177 

4.557 

S-695 

11.392 

18.228 

I  in  300 

i-5»9 

3035 

4-557 

6.076 

7-59 

15-19 

24.304 

I  in  200 

2.2785 

4-557 

6-8355 

9. 1 14 

"•39 

22.785 

36.456 

I  in  TOO 

4-557 

9.114 

13.671 

18.228 

22.785 

45-57 

72.912 

1  in  50  . 

9. 114 

18.228 

27.342 

36.456 

45-57 

91.14 

145.824 

I  in  25  . 

18.228 

36.456 

54.684 

72.912 

91.14   !  182.28 

291.648 

I  in  10  . 

45-570 

91.140 

136.710 

182.280 

227.85     45570 

729.120 

I  in  5    . 

91.14 

182.28 

273-42 

364.56 

455-7      9"-4 

1458.24 

The  rule  for  finding  the  amount  of  a  drug  in  a  given  percentage  of  solution  is 
as  follows : 

Find  the  number  of  minims  in  stated  quantity,  and  multiply  this  by  the  num- 
bers indicating  percentage,  placing  the  decimal  two  points  to  the  left. 

Examples :  i.  How  many  grains  of  drug  in  2  fluid  ounces  of  a  2  per  cent, 
tincture  (solution)  ?  Two  fluid  ounces  =  960  (TTl,)  X  (2  P-  c.)  =  19.20  grains. 
2.  How  many  grains  of  a  drug  in  100  C.C.  of  a  4  (p.  c.)  tincture  (solution)? 
100  C.C.  X  ^6.23  =  1623.00  (KlfL)  X  4  (P-  c.)  =  64.92  grains. 

ABBREVIATIONS. 

In  medical  prescriptions,  letters,  parts  of  words,  or  certain 
symbols,  are  employed  as  abbreviations,  to  designate  the  sub- 
stance, quantity,  etc.,  as  follows  : 


ABBREVIATION. 


LATIN  WORD. 


ENGLISH  WORD. 


A, 

Argon.  Anterior. 

Anode, 

A.C.C., 

Anodal  closure  contraction. 

aa, 

Ana  (G.), 

Of  each. 

Ad., 

Add, 

Ad  Saturand., 

Ad  saturandum. 

Until  saturated. 

Ad  lib.. 

Ad  libitum, 

At  pleasure. 

ABBREVIATIONS  FOR  PRESCRIPTIONS. 


23 


ABBREVIATION. 

LATIN  WORD. 

ENGLISH  WORD. 

Amp., 

Ampere 

Aq., 

Aqua, 

Water. 

Aq.  tepid., 

Aqua  tepida. 

Warm  water. 

Aq.  ferv.. 

Aqua  fervens, 

Hot  water. 

Aq.  dest, 

Aqua  destillata, 

Distilled  water. 

At.  wt., 

Atomic  weight, 

C.  or  Cong., 

Congius, 

A  gallon. 

Chart., 

Chartula, 

A  small  paper. 

Coch., 

Cochlear, 

A  spoonful. 

Coch.  mag.. 

Cochlear  magnum. 

A  tablespoon  ful. 

Coch.  parv.. 

Cochlear  parvum, 

A  leaspoonful. 

Colent., 

Colentur, 

Let  them  be  strained. 

Collyr., 

Collyrium, 

An  eye-water. 

Comp., 

Compositus, 

Compound. 

Contus., 

Contusus, 

Bruised  or  broken. 

Cort., 

Cortex, 

Bark. 

Ext., 

Extractum, 

An  extract. 

F.  or  Ft., 

Fiat  vel  fiant, 

Let  them  be  made. 

Fol., 

Folium  vel  folia, 

A  leaf  or  leaves. 

Garg,, 

Gargarysma, 

A  gargle. 

Gr., 

Granutii  vel  grana, 

A  grain  or  grains. 

Gtt., 

Gutta  vel  guttae. 

A  drop  or  drops. 

Haust., 

Haustus, 

A  draught. 

Infus., 

Infusum, 

An  infusion. 

M., 

Misce, 

Mix. 

Mass., 

Massa, 

A  mass. 

Mist., 

Mistura, 

A  mixture. 

0., 

Octarius, 

A  pint. 

Pil., 

Pilula  vel  pilulse, 

A  pill  or  pills. 

Pulv., 

Pulvis  vel  pulveres, 

A  powder  or  powders. 

q.  s.. 

Quantum  sufficit. 

A  sufficient  quantity. 

R.. 

Recipe, 

Take. 

Rad., 

Radix, 

A  root. 

S., 

Signa, 

Write  or  give  directions. 

Spts., 

Spiritus, 

Spirits. 

ss., 

Semis, 

The  half. 

Syr., 

Syrupus, 

Syrup. 

Tinct, 

Tinctura, 

A  tincture. 

lb., 

Libra, 

A  pound. 

,?. 

Uncia, 

An  ounce. 

^' 

Drachma, 

A  drachm. 

9. 

Scrupulus, 

A  scruple. 

f.l. 

Fluiduncia, 

A  fluid  ounce. 

^5' 

Fluidrachma, 

A  fluid  drachm. 

m. 

Minim, 

A  drop. 

24  DENTAL  MEDICINE, 


Although  the  symbol  (W)  is  adopted  in  the  United  States 
Pharmacopoeia  to  designate  a  drop,  it  should  be  remembered  that 
the  size  of  a  drop  varies  according  to  the  greater  or  less  fluidity 
and  gravity  of  the  liquid,  and  the  shape  of  the  mouth  of  the  bot- 
tle from  which  it  is  dropped.  It  is  best  to  use  a  glass  medicine- 
dropper,  or  a  small  vial  with  a  thin  edge  of  mouth,  when  great 
precision  is  necessary,  and  to  dilute  the  active  medicine  and  ad- 
minister it  in  the  form  of  a  mixture ;  for  in  some  preparations, 
one  hundred  and  fifty  drops  would  measure  but  a  fluidrachm, 
while  in  others  the  same  number  of  drops  would  be  somewhat 
more  than  three  fluidrachms. 

But  there  is  a  wide  difference  between  a  drop  and  a  minim, 
and  although  a  drop  is  usually  considered  as  one-sixtieth  part 
of  a  fluidrachm,  this  is  only  true  of  water  and  some  other  liquids, 
and  drops  of  the  same  liquid  vary  under  different  circumstances. 
Specific  gravity,  viscidity  or  adhesiveness,  and  mobility  modify 
the  size  of  drops.  The  heavier  the  liquid  the  smaller  will  be  the 
drops,  and  the  greater  number  in  a  given  measure. 

The  drops  from  a  thick-lipped  bottle  are  larger  than  those 
from  one  having  thin  lips  ;  and  drops  from  a  full  bottle  are  gen- 
erally smaller  than  those  from  a  bottle  partially  filled,  on  account 
of  rapidity  of  movement.  The  adhesiveness  of  a  liquid  to  the 
sides  of  a  bottle  increases  the  size  of  the  drops,  as  a  greater  mass 
is  necessary  to  overcome  the  viscidity.  Drops  are  also  increased 
in  size  by  the  greater  mobility  of  a  liquid. 

A  tablespoon/hi  of  any  liquid  is  regarded  as  equal  to  half  an 
ounce  by  measure ;  and  a  teaspoonful  equal  to  2i  fluidrachm ;  and 
such  measures  are  sufiiciently  accurate  where  no  great  precision 
is  requisite.  ' 

A  gallon  contains  eight  pints. 

A  pint  contains  sixteen  fluid  ounces. 

A  fluid  ounce  contains  eight  fluidrachms. 

A  fluidrachm  contains  sixty  minims  (1U). 

A  wine  glass  (approximate  measurement)  contains  two  fluid 
ounces. 

A  teacup  (approximate  measurement)  contains  four  fluid 
ounces. 


MEASURING  LIQUIDS  BY  DROPS. 


25 


A  tablespoon  of  powder  (approximate  measurement)  contains 
two  drachms. 

A  teaspoon  of  powder  (approximate  measurement)  contains 
one-half  drachm. 

One  drop  of  water  (small  drop,  approximate  measurement) 
contains  one  minim. 

One  drop  of  essential  oils  (approximate  measurement)  contains 
one-half  minim. 

A  graduated  measure-glass  is  the  most  accurate  measure,  as 
spoons,  glasses,  etc.,  vary  greatly  in  size. 

MEASURING    LIQUIDS    BY    DROPS. 

In  measuring  liquids  by  drops,  a  glass  medicine-dropper  should 
be  used,  as  the  uncertainty  of  dropping  from  various  shaped  bot- 
tles should  not  be  depended  upon. 

The  following  list  shows  the  relative  differences  between 
drops  and  minims  of  a  few  of  the  drugs  used  in  dental  practice. 


Number  of  Drops  in  Sixty  Minims- 

Carbolic  Acid in 

Sulphuric  Acid 128 

Sulphuric  Acid  (dilute)    ....  60 

Aromatic  Sulphuric  Acid     .     .     .  146 

Ether 172 

Alcohol 146 

Alcohol  (dilute) 137 

Aqua  Destillatae 60 

Aqua  Ammonia      ......  64 

Chloroform  (purified)       ....  250 

Creosote 122 

Fl.  Extract  of  Ergot 133 

Glycerine 67 

Liq.  Chloride  of  Zinc     ....  89 

Oil  Cajeput 134 


Oil  Cloves 130 

Oil  Cinnamon 126 

Oil  Wintergreen 125 

Oil  Peppermint 129 

Oil  Sassafras 133 

Oil  Turpentine 136 

Aromatic  Spts.  of  Ammonia     .     .  142 

Spts.  Camphor 143 

Syrups 65 

Tinct.  Aconite 146 

Tinct.  Benzoin  (Comp.) ....  148 

Tinct.  Digitalis 128 

Tinct.  Chloride  of  Iron  .     .     .     .150 

Tinct.  Opii 13° 

Vinum  Opii loo 


FINENESS    OF    POWDER. 


The  fineness  of  powder  is  denoted  either  by  descriptive  words 
(as  in  the  case  of  brittle  and  easily-pulverizable  substances),  or  in 
terms   expressing  the   number  of  meshes  to  a  linear  inch  in  the 


26  DENTAL  MEDICINE. 


sieve.     The  following  degrees  of  fineness  will  prove  serviceable 
in  the  preparation  of  dentifrices,  polishing  powders,  etc.  : — 

(  Should  pass  through  =»  ) 

A  "y^ry /7«^  powder   .     .     ,  ^  sieve  having  80  or  more  ^  ^i\o.  00  rowuer. 

-^  (    meshes  to  linear  inch.   ) 

(  Should  pass  through  a  )  /-         r>  i 

A   /f«^  powder ^  sieve  having  60  meshes  [=; No.   DO    Powder. 

-'  (to  the  linear  inch.       5 

1  \  Should   pass  through  a  >         -  -  n  j 

A  moaerateiy  fine  powder     .<  sieve  having  50  meshes  v  =;l\o.  "CO  rowder. 

•^  -^  '  {       to  the  linear  inch.       )  -^ 

(  Should  pass   through  a  )  r»  i 

A  moderately  coarse  powder.  <seive  having  40  meshes  v  =;jNo.  40  rowder. 

(       to  the  linear  inch.        ) 
,  J  (  Should  pass   through  a"| 

A  coarse  pOV/aeV    .        .        .        .  ^  sieve  having  20  meshes  ^  =  I\0.    20     TOWdcr. 

(       to  the  linear  inch.       ) 


WEIGHTS  AND  MEASURES. 

APOTHECARIES'  WEIGHT. 

20  grains  (gr.)  make  1  scruple sc.  or  ^ 

3  scruples        make  i  drachm dr.  or  z 

8  drachms       make  i  ounce oz.  or  5 

12  ounces  make  i  pound lb.  or  tb 

SCALE   OF   COMPARISON. 
ft)  oz.  dr.  so.  gr. 

I  =  12  =  96  =r  288  =  5760 

1            ^               8            =              24  =  480 

I             =                3  =  60 

I  ^  20 
TROY  WEIGHT. 

24  grains  (gr.)      make  i  pennyweight dwt. 

20  pennyweights  make  i  ounce oz. 

12  ounces  make  i  pound      ft). 

3/4  grains  make  i  carat  (diamond  weight) k. 

SCALE  OF   COMPARISON. 

ft)                                       oz.                                       dwt.  gr. 

I                  =                  12                  =                  240  ^  5760 

I                   ==                    20  =  480 

I  =  24 

Ik.  =  3}i 

AVOIRDUPOIS  WEIGHT. 

16  drachms  (dr.)  make  I  ounce oz. 

16  ounces  make  i  pound         ft). 

25  pounds  make  i  quarter       qr. 

4  quarters  make  I  hundredweight cwt. 

20  hundredweight  make  I  ton T. 

100  pounds  make  i  central C. 


WEIGHTS  AND  MEASURES. 


SCALE 

OF 

COMPARISON, 

qr. 

lb. 

oz. 

dr. 

So 

^ 

2000 

= 

32000 

= 

512000 

4 

= 

lOO 

= 

4000 

= 

25600 

I 

= 

25 

= 

400 

= 

6400 

I 

=^ 

16 

I 

= 

256 
16 

T.  cwt. 

1  =  20 

I 


THE     METRIC     OR     FRENCH     DECIMAL     SYSTEM    OF    WEIGHTS    AND 

MEASURES. 

The  metric  system  is  based  upon  the  meter,  which  is  the 
standard  unit  of  lefigth  of  that  system,  and  equal  to  39^370,432 
inches,  or  about  10  per  cent,  longer  than  the  yard. 

The  metric  unit  o^  fiu'id  ?ueasure  is  the  liter — the  cube  of 
^Q  meter,  or  1000  cubic  centimeters — equal  to  about  34  fluid 
ounces. 

The  metric  unit  of  weight  is  the  Gram,  which  represents  the 
weight  of  one  cubic-centimeter  of  water  as  its  maximum 
density.     It  is  equal  to  15  (43,234,874)  troy  grains. 

One  cubic-centimeter  is  equal  to  16,231  minims. 

In  writing  prescriptions  it  is  sufficiently  accurate 
and  safe  to  consider  i  gram  as  exactly  equal  to  1 5 
troy  grains,  and  to  consider  i  cubic  centimeter  as  equal 
to  15  minims. 

We  accordingly  have — 

I  gram  equal  to  y  troy  grains. 

I  troy  grain  equal  to  yV  gram. 

I  cubic  centimeter  equal  to  \  fluidrachm. 

I  fluidrachm  equal  to  f  cubic  centimeter. 

Hence — 

1.  To  CONVERT  TROY  GRAINS  INTO  GRAMS,  OR  MINIMS  INTO 
CUBIC  CENTIMETERS — 

a.  Divide  by  10^  and  from  the  quotient  subtract  one-third;  or.,  b. 
Divide  by  75 ;  and 

2.  To  CONVERT  apothecaries'  DRACHMS  INTO  GRAMS,  OR 
FLUIDRACHMS  INTO  CUBIC  CENTIMETERS,  multiply  by  ^. 

In  writing  prescriptions,  the  "gram"  (abbreviated  "  Gm.") 
and  "cubic  centimeter"  (abbreviated  "C.C.,"  which  may  be 
called  "  fluigram,"  and  written  "  fGm  ")  only  should  be  used. 


28  DENTAL  MEDICINE. 

The  centigram,  which  is  a  very  convenient  unit  to  refer  to  in 
medicine  and  pharmacy,  is  used  in  books  and  in  speaking,  but 
not  in  writing  prescriptions. 

All  other  terms,  and  units,  and  prefixes  used  in  the  metric 
system,  may  be  wholly  ignored  by  the  physician  and  the  phar- 
macist. * 

The  use  of  a  decimal  line  prevents  possible  errors. 

To  write  a  prescription  for  fifteen  doses  of  any  medicine,  write 
it  first  for  one  dose  in  grains  and  minims^  and  then  substitute  the 
same  number  of  "grams  "  and  "  cube-cents,"  thus  : — 

R-    Opii gr.  j 

Camphorse gr-  U 

Make  one  pill.  < 

and  to  get  fifteen  such  doses  in  metric  terms,  write  — 

K;.     Opii I  Gm. 

Camphorse 2  Gm. 

Make  fifteen  pills. 

The  gram  and  the  cubic  centimeter  (^fiuigrani)^  when  referring 
to  liquids,  may  be  considered  as  equal  quantities,  except  the 
liquids  be  very  heavy  (as  in  the  case  of  chloroform),  or  very 
light  (as  in  the  case  of  ether). 

Measures  may  be  discarded  and  weights  exclusively  employed, 
if  preferred.  All  quantities  in  a  prescription  would  then  be  ex- 
pressed in  GRAMS,  f 

*  The  prefixes  are  simply  numerals,  as  follows : — 

myria,  which  means  10,000. 

kilo,  "  "         1,000. 

Aecfo,         "  "  100. 

{/eka,  "  "  10. 

and  are  quite  unnecessary  in  the  writing  of  prescriptions  (if  not  in  all  cases), 
English  numerals  being  more  convenient,  and  at  least  equally  explicit. 

EXAMPLE   OF  A   METRIC   PRESCRIPTION. 

R .  Hydrarg.  chloridi.  corros o    25  Gm. 

Potassi  iodidi ^     10  00  Gm. 

Aquae 100  00  C.C. 

Tinct.  cinch,  comp 100  '  00  C.C. 

Mix. 
t  As  any  liquid  medicine  must  necessarily  be  administered  to  the  patient  in 
measured,  and  not  in  weighed,  doses,  it  will,  of  course,  be  more  convenient  to  the 


deci,  which  means  o.i. 
centi,     '"         "      0.0 1. 
milli,      "         "      0.00 1. 


TABLE  OF  EQUIVALENTS. 


29 


The  average  "  drop  "  (water)  mav  be  considered  equal  to 
0.05  CC,  or  0.05  Gm.  An  average  teaspoon  holds  5  C.  C, 
and  an  average  tablespoon  20  C.C.  Decimal  numbers  should 
be  used  as  far  as  practicable  without  sacrifice  of  accuracy  as  to 
strength  and  dose  of  the  preparation.  It  is  safe  to  prescribe 
30  Gm.  for  one  troy  ounce,  and  250  C.C.  for  eight  fluid  ounces. 

The  above  contains  all  that  is  necessary  to  know  or 
LEARN  of  the  metric  system,  in  order  to  write  metric  pre- 
scriptions, without  a  metric  posological  table,  or  with  one. 

To  become  familiar  with  the  system,  the  rules  given  above  for 
the  conversion  of  apothecaries'  weights  and  measures  into  the 
corresponding  metric  quantities,  may  be  profitably  used,  the  re- 
sults to  be  verified  by  comparison  with  the  following  — 


TABLE  OF  EQUIVALENTS. 


apothecaries' 

METRIC 

apothecaries' 

metric 

WEIGHTS 

weights 

weights 

weights 

(and  measures). 

(and  measures^. 

(and  measures). 
Drachms 

(and  measures). 

Troy  grains 

Grams 

or  cubic 

G  ra  ms 

{or  tninints). 

centhneters).  ■ 

(or  ^uiiirac/ims) . 

{or  cubic  centimeters). 

^h 

0.00 1 

(nnre) 

I 

4 

A 

0.002 

ij-^Ts) 

2 

8 

tV 

0.004 

(toVit) 

4 

16 

i 

o.ooS 

(t^Vo) 

6 

24 

^i 

0.016 

(A) 

Troy  ounces  [or  flu 

'd ounces). 

I 

0.033 

(tV) 

I 

32 

I 

0.066 

(tV) 

2 

64 

2 

0.133 

(A) 

4 

128 

5 

0.333 

G) 

6 

192 

10 

0.666 

(1) 

8 

256 

IS 

1.000 

(0 

12 

384 

20 

J -333 

(H) 

16 

512 

30 

2.000 

(2) 

The  adoption  of  the  metric  system  of  weights  and  measures  is 

physician  to  continue  to  make  use  of  fluid  measures  in  writing  prescriptions,  es- 
pecially as  he  is  aheady  accustomed  to  this,  and  would  not  then  have  to  bear  in 
mind  the  specific  gravity  of  avy  hquid  ingredient  in  the  prescription.  To  the 
pharmacist  it  makes  hut  little  difference,  as  he  will  have  both  weights  and  meas- 
ures, and  can  use  one  or  the  other,  as  may  be  directed.  If  the  physician  discards 
measures,  he  must,  of  necessity,  so  adjust  the  proportion  in  his  formula  as  to  pro- 
duce a  mixture  of  which,  after  all,  the  dose  must  be  a  "  teaspoonful,"  or  some 
other  convenient  measure,  and  this  is  as  unnecessary  as  it  is  difficult. —  Oscar 
Oldberg,  Phar.  D.,  in  Blackiston's  Phys.   Visiting  List. 


30  DENTAL  MEDICINE. 


a   matter  of  time  only.     Its  advantages  over  other  svstems  are 
well  recognized. 

RULES  FOR  REGULATING  DOSES. 

The  doses  given  in  this  work  are  applicable  to  adult  age  unless 
the  contrary  is  specified ;  and  for  the  convenience  of  students, 
the  rules  of  Gaubins  and  Young  for  determining  the  proper  dose 
of  medicines  for  children  are  furnished  below. 

Take  the  dose  for  an  adult  as  unity,  and  for  other  ages  as 
follows : — 

The  dose  for  a  person  of  middle  age  being  i,  or  i  drachm, — 

That  for  a  person  from  14  to  21  years  will  be  %,  or    2  scruples. 


It                          l< 

7 

to 

14    " 

yitOt  yi  &  drachm. 

41                                      « 

4 

to 

7    " 

>^,  or    I  scruple. 

««      a  child  of 

4    " 

%,ox  15  grains. 

X                       <l 

3    " 

\,  or  10  grains. 

ti                II 

2    « 

^,  or    8  grains. 

<l              l< 

I  year 

^,  or    5  grains. 

The  following  simple  rule  by  Dr.  Young  will  be  found 
convenient :  "  For  children  under  twelve  vears,  the  doses  of 
most  medicines  must  be  diminished  in  the  proportion  of  the 
age  to  the  age  increased  by  12;  thus,  at  two  years  to  ^;  viz: 

2         I.     At  twenty-one  the  full  dose  may  be  given." 


i+iz     7 

Hence  — 

For  one  year, 

I              I 

I  +  12-  13 

For  two  years, 

2                 I 

2+12—    7 

For  three  years, 

3             I 

3+  "       5 

For  four  years, 

4             I 

4+  la        4 

For  six  years. 

6             I 

6+12        3 

At  twelve  years  the  dose  is  one  half  that  of  the  adult.  The 
U.  S.  Dispensatory  states  that  "  To  the  above  rules  some  excep- 
tions  are   offered,  in   particular   medicines,  which   require   to  be 


RULES  FOR  REGULATING   DOSES.  81 


given  to  childrcji  in  much  larger  proportional  doses  than  those 
above  stated.  Such  as  castor  oil  and  calomel,  a  certain  quantity 
of  which  will,  in  general,  not  product*  a  greater  effect  in  a  child 
two  or  three  years  old  than  double  the  quantity  in  an  adult." 
"  Females  usually  require  smaller  doses  than  males,  and  persons 
of  sanguine  temperament  than  the  phlegmatic."  The  influence 
of  constitutional  peculiarities,  such  as  are  known  as  idiosyncrasies, 
often  exist  and  render  patients  more  than  usually  susceptible,  or 
the  opposite,  to  the  action  of  medicines,  the  doses  of  which  must 
be  regulated  accordingly.  It  should  also  be  remembered  that  the 
susceptibility  to  the  action  of  medicines  is  diminished  by  frequent 
and  continued  use.  In  advancing  age,  the  dose  is  gradually 
lessened. 

Opiates  aff^ect  children  to  a  greater  degree  than  adults,  but 
children  bear  larger  doses  of  calomel  than  adults.  Females  are 
more  rapidly  affected  by  purgatives  than  males,  and  the  condition 
of  the  uterine  system  is  very  important. 

Medicinal  substances  act  differently  on  the  same  person  in 
summer  and  in  winter,  and  in  different  climates.  Narcotics  act 
more  energetically  in  hot  than  in  cold  climates,  and,  as  a  conse- 
quence, smaller  doses  are  required  in  hot  climates ;  the  opposite 
is  the  case  with  regard  to  calomel.  Owing  to  peculiarity  of 
stomach,  or  rather  disposition  of  body,  unconnected  with  tem- 
perament, comparatively  mild  remedies  operate  very  violently  on 
some  individuals. 

When  administering  remedies,  the  intervals  between  the  doses 
should  be  so  regulated  that  the  second  dose  may  be  taken  before 
the  effect  produced  by  the  first  is  entirely  effaced.  Some  me- 
dicinal substances,  such  as  mercurial  salts,  arsenic,  etc.,  are  prone 
to  accumulate  in  the  system ;  and  dangerous  symptoms  may  arise 
if  the  doses  rapidly  succeed  one  another. 

The  action  of  some  remedies,  such  as  digitalis,  elaterium,  etc., 
may  continue  long  after  the  discontinuance  of  the  agent,  and  a 
too  powerful  effiect  occur,  even  by  a  repetition  in  diminished 
doses.  Some  remedies,  such  as  castor  oil,  aloes,  etc.,  acquire 
activity  by  continued  use,  hence  the  dose  requires  to  be  dimin- 
ished. 


32  DENTAL  MEDICINE. 


TOPICAL  REMEDIES. 

Medicinal  substances  are  applied  to  the  mucous  membrane  of 
the  mouth  and  to  the  dental  structures  almost  exclusively  for  local 
effects.  In  dental  practice  antiseptic  remedies  are  extensively 
employed  to  arrest  fermentative  and  putrefactive  processes,  as  every 
kind  of  fermentation  depends  upon  the  growth  and  increase  of  a 
living  organism.  Various  diseases  of  the  dental  structures  have 
a  close  relationship  with  low  organisms  in  the  morbid  processes 
which  result  during  their  progress,  and  which  are  maintained  and 
developed  by  the  presence  of  living  matter.  The  remedies  rec- 
ognized as  belonging  to  the  group  of  antiseptics,  when  brought 
into  contact  with  the  disease  germs,  which  are  constituted  of 
these  organized  forms  of  life,  have  the  power  of  destroying  their 
vitality  and  of  arresting  the  fermentative  or  putrefactive  process 
which  they  either  develop  or  promote.  The  effect  of  escharotics 
when  applied  to  a  part  of  which  the  structure  and  vitality  are  to 
be  destroyed,  is  to  produce  an  eschar  and  incite  inflammation  and 
suppuration  of  the  adjacent  tissues,  by  which  the  slough  is  sep- 
arated from  the  living  parts. 

Medicinal  substances  are  applied  to  the  mucous  membrane  of 
the  mouth  in  the  form  of  gargles  or  mouth-washes,  lotions  and 
injections,  and  generally  for  a  local  effect. 

Medicinal  substances  are  applied  to  the  skin  for  both  a  local 
and  general  effect,  either  by  friction,  by  the  endermic,  or  by  the 
hypodermic  methods.  In  the  endermic  method^  the  cuticle  is  usually 
removed  by  the  action  of  a  blister,  and  the  medicinal  agent  is  ap- 
plied to  the  denuded  surface  in  the  form  of  a  powder  or  ointment, 
and  is  a  useful  method  when  the  irritability  of  the  stomach  or 
difficult  deglutition  prevents  medicines  from  being  taken  through 
the  mouth. 

Hypodermic  Injection. — The  hypodermic  method  consists  in  inject- 
ing medicines  by  means  of  a  graduated  syringe  with  a  sharp- 
pointed  nozzle,  and  constructed  for  the  purpose,  into  a  subcuta- 
neous cellular  tissue,  thus  producing  both  a  local  and  general  effect, 
and  an  impression  is  made  much  more  rapidly  than  when  the 
medicine  is  taken  into  the  stomach.  It  is  necessary  that  the 
remedy  should  be  applied  beneath  the  skin,  or  mucous  membrane, 


TOPICAL  REMEDIES. 


and  that  it  should  not  be  injected  into  any  large  vessel ;  hence 
for  hypodermic  injections  a  locality  should  be  selected  free  from 
nerves,  veins,  or  large  vessels,  and  not  the  same  locality  in  subse- 
quent injections.  The  medicinal  agents  used  for  hypodermic  in- 
jections are  now  prepared  in  the  form  of  tablets  which  are  per- 
fectly soluble,  and  of  considerable  strength  in  small  bulk.  They 
are  dissolved  in  pure  or  distilled  water  at  the  time  the  injection  is 
to  be  made,  and  great  accuracy  is  thus  obtained.  Anodynes  thus 
used  are  more  rapid  in  their  effect,  and  the  general  rule  as  re- 
gards the  quantity  is,  that  in  first  injections  the  dose  should  be, 
for  males,  two-thirds  of  the  ordinary  dose  by  the  stomach  and 
for  females  about  one-half.  It  is  very  necessary  that  a  vein  or 
large  vessel  should  not  be  punctured  when  introducing  the  point 
of  the  syringe.  The  insertion  of  the  deltoid  muscle  in  the  arm 
is  generally  selected  as  the  place  of  injection,  and  the  needle- 
point of  the  syringe  should  not  be  inserted  too  deep  nor  at  the 
same  point  in  subsequent  injections.  Hypodermic  injections 
may  also  be  made  in  the  back,  front  of  thigh — ^just  in  front  of 
trochanters,  and  in  the  calf  of  the  leg.  A  graduated  syringe  is 
required,  and  the  point  of  the  needle  pushed  through  the  skin,  or 
mucous  membrane  until  it  works  easily  in  the  tissues  beneath  ; 
then  inject  slowly,  and  when  withdrawing  the  point,  press  the 
finger  firmly  over  the  puncture  for  a  minute,  to  prevent  the  fluid 
escaping.  The  effects  of  a  medicine  are  much  more  rapidly  ob- 
tained by  the  hypodermic  method  than  when  administered  by  the 
mouth.  In  dental  practice  this  method  is  employed  for  the  relief 
of  neuralgia,  and  the  pain  attending  the  extraction  of  teeth ;  also 
for  the  administration  of  ergot  in  cases  of  alveolar  hemorrhage. 
There  are  two  dangers  from  hypodermic  injection — the  needle 
may  enter  a  vein  and  the  entire  dose  may  be  carried  at  once  to 
the  vital  centres, — the  solution  or  needle  used  may  not  be  sterile 
and  an  abscess  be  produced. 

Counter-irritants.- — Medicinal  substances  of  the  classes  of  rube- 
facients and  epispastics  are  employed  as  counter-irritants^  their 
effect  being  to  establish  external  or  artificial  irritation  for  the  re- 
lief or  cure  of  internal  inflammation  existing  in  a  part  or  in  the 
body.  The  extent  and  character  of  the  counter-irritation  thus 
3 


34  DENTAL  MEDICINE. 


established  should  be,  in  a  great  measure,  regulated  by  the  char- 
acter of  the  disease  which  it  is  intended  to  relieve  ;  a  rubefacient 
being  indicated  in  irritation  of  mucous  membrane,  a  seton  or 
issue  when  the  disease  is  of  a  suppurative  character,  and  a  vesi- 
cant in  inflammation  of  serous  membranes. 

Setons  and  Issues  are  employed  to  produce  permanent  counter- 
irritant  effects.  A  seton  consists  of  a  skein  of  silk  or  a  piece  of 
tape  or  other  substance  passed  through  the  integument  by  means 
of  a  seton-needle,  and  allowed  to  remain,  so  that  a  discharge  is 
maintained.  A  simple  seton  in  the  case  of  an  incision  into  an 
alveolar  abscess,  is  composed  of  a  single  or  a  double  strand  of 
floss  silk  introduced  into  the  wound  made  by  the  lancet,  or  into 
the  orifice  of  a  fistulous  opening,  after  the  pus  of  the  abscess  has 
been  evacuated,  to  maintain  a  free  exit  for  the  pus  which  may  be 
secreted  after  the  first  operation  ;  fine  silver  wire  is  also  employed 
for  the  same  purpose.  An  issue  is  generally  some  irritating  sub- 
stance, such  as  caustic  potassa,  or  a  small  pea,  or  piece  of  orris 
root  introduced  in  order  to  maintain  a  discharge. 

Blood-letting  is  performed  for  the  purpose  of  lessening  vascular 
excitement,  reducing  inflammatory  action,  relieving  congestive 
pain  and  spasm,  promoting  absorption,  relaxing  the  muscles  and 
arresting  hemorrhage.  It  is  divided  into  ^^n^ra/ and /or«/,  general 
blood-letting  consisting  of  venesection  or  phlebotomy,  the  median 
cephalic  or  basilic  veins  of  the  arm,  and  occasionally  the  external 
jugular  and  other  veins,  being  the  ones  selected  from  which  to 
draw  the  blood.  But  it  should  be  resorted  to  with  caution,  as  it 
is  a  powerful  and  exhausting  agent. 

Local  Blood-letting  is  chiefly  employed  for  the  relief  of  local 
inflammations  and  congestions,  and  is  accomplished  by  means  of 
leeches,  cups,  and  scarifications. 

The  leech — hirudo — is  commonly  employed  as  an  agent  for 
local  blood-letting,  and  is  preferable  to  "  cupping  "  in  many  local 
and  chronic  forms  of  inflammation  ;  also  in  infantile  aff^ections 
which  require  such  an  operation,  when  the  American  leech  is 
used,  and  it  makes  a  smaller  incision  than  the  European  leech, 
and  draws  less  blood.  A  leech  is  supposed  to  draw  on  an  average, 
about  a  drachm  and  a  half  to  two  drachms  of  blood  before  it  is 


THERAPEUTICS  OF  ELECTRICITY.  35 

removed,  and  the  quantity  which  subsequently  flows  will  generally 
equal  that  drawn  by  the  leech. 

Leeches  are  often  applied  to  the  gum  over  the  root  of  a  tooth 
affected  with  acute  periodontitis,  to  relieve  the  inflammation  and 
congestion.  To  make  the  leech  bite  readily,  the  surface  to  which 
it  is  to  be  applied  may  be  smeared  with  cream  or  sweet  milk,  or 
a  puncture  may  be  made  in  it,  so  as  to  draw  blood,  and,  to  isolate 
the  part  of  the  surface  on  which  it  is  desired  to  apply  the  leech, 
a  small  hole  may  be  made  in  a  piece  of  bibulous  paper,  which 
will  adhere  to  a  dry  surface  of  the  gum,  and  afford  an  opening 
for  the  mouth  of  the  leech  to  approach  the  surface. 

To  remove  a  leech  if  it  does  not  drop  off  of  its  own  accord 
which  they  will  generally  do  in  from  fifteen  to  twenty  minutes,  it 
may  be  sprinkled  with  a  little  cold  water  or  diluted  vinegar,  or 
powdered  sugar.  To  promote  bleeding  from  leech  bites,  fomen- 
tations or  warm  dry  cloths,  or  a  cupping  glass,  may  be  used.  To 
check  the  hemorrhage  from  leech  bites,  which  is  sometimes  ex- 
cessive, firm  pressure  may  be  made  with  the  finger,  or  exposure 
to  cold  air,  or  the  application  of  such  styptics  as  alum  or  matico. 

Cupping  is  employed  when  it  is  desired  to  draw  blood  rapidly, 
or  to  ascertain  the  exact  quantity  of  blood  drawn,  or  when  it  is 
desirable  to  make  an  impression  on  the  system.  Cupping  is  per- 
formed by  means  of  cupping  glasses  and  a  scarificator.  The 
glasses  are  applied  after  being  partially  exhausted  of  air,  when 
the  removal  of  the  atmospheric  pressure  produces  a  determination 
of  blood  to  the  capillaries  of  the  part,  and  it  is  afterwards  easily 
drawn  by  scarification. 

Scarifications  consist  of  small  incisions  made  in  inflamed  and 
congested  parts,  to  relieve  the  engorged  condition  of  the  capillary 
vessels,  and  are  sometimes  employed  to  relieve  acute  inflammation 
of  the  gums  and  mucous  membrane  of  the  mouth. 

ELECTRICITY  AS  A  THERAPEUTIC  MEANS  IN  THE  TREATMENT 

OF  DISEASE. 

Electricity  is  a  powerful  agent  in  many  forms  of  nervous  dis- 
ease, especially  in  the  treatment  of  paralysis  and  neuralgia. 

Three  forms  of  electricity  are  employed,  viz  :  The  induced  cur- 


36  DENTAL  MEDICINE. 

rent^  the  galvanic  current^  both  of  which  are  dynamical,  and  the 
static  current^  which  is  frictional. 

Galvanic  electricity — galvanism,  and  induced  electricity — 
faradism,  are  the  two  forms  generally  employed,  frictional  elec- 
tricity being  but  seldom  applied.  What  is  known  as  electro-mag- 
netism is  a  form  of  induced  current,  generated  by  the  rotary  in- 
strument, and  is  not  reliable.  Faradism,  so-called  from  its  dis- 
coverer, is  generated  by  an  instrument  which  is  capable  of  apply- 
ing slow  or  rapid  shocks,  and  giving  what  is  denominated  a  fine, 
strong,  induced  current.  It  consists  of  coils  of  wire ;  a  small 
hammer  of  soft  iron,  attached  to  a  spring ;  a  pole  containing  a 
platinum-pointed  screw,  the  hammer  breaking  the  current  in  the 
coil  of  wire,  and  by  rapid  vibration  producing  shocks. 

"  The  galvanic  current  is  generated  by  a  series  of  cells,  suffi- 
cient in  number  to  cause  a  current  of  tension,  which  is  the 
resistance  offered  to  the  passage  of  a  current. 

*'  One  cell  supplies  a  current,  the  poles  of  other  cells  being 
alternately  joined,  and  there  are  finally  but  two  terminal  poles." 
As  the  current  from  the  first  cell  passes  through  the  remaining 
cells,  its  power  is  increased  and  the  effect  is  governed  by  the 
number  of  cells  belonging  to  the  circuit.  There  is  also  what 
is  dominated  a  current  of  "  quantity,"  which  is  generated  by  a 
large  metallic  surface  in  the  battery  cell,  the  tension  current 
being  generated  by  a  number  of  small  metal  plates.  The  "  ten- 
sion current "  serves  the  best  purpose  for  medical  use,  while 
the  "  quantity  current "  furnishes  heat,  and  is,  therefore,  adapted 
to  purposes  of  electro-surgery.  The  modified  Bunsen  galvanic 
cell  is  the  best  for  medical  purposes,  although  what  is  known  as 
the  Siemens  and  Halske  cell  is  extensively  used ;  "  it  consists  of 
an  outer  cell  of  glass,  with  elements  of  zinc  and  copper,  a  dia- 
phragm of  porous  earthenware,  and  a  diaphragm  of  papier  mache, 
between  the  solutions."  The  Holtz  electric  instrument  furnishes 
the  best  static  current. 

The  Ruhmkorff  coil  is  also  employed,  in  the  use  of  which  but 
one  wire  is  brought  in  contact  with  the  patient,  the  other  con- 
ductor being  formed  by  the  air,  and  a  spark,  similar  to  the  ordi- 
nary spark  from  the  friction  machine,  being  produced. 


THERAPEUTICS  OF  ELECTRICITY.  37 


When  electricity  is  applied  to  the  body,  sponges  of  different 
sizes,  or  polished  metallic  surfaces,  known  as  "  electrodes,"  the 
metallic  being  the  best,  are  employed,  the  effect  upon  the  skin 
being  similar  to  what  is  caused  by  puncturing  with  many  small 
needles.  The  theory  of  electro-therapeutics  is  dependent  upon  the 
following  effects  : — 

"  If  a  portion  of  a  motor  nerve  is  included  between  the  poles 
of  a  galvanic  battery,  it  is  said  to  be  polari%ed^  and  in  a  state  of 
electrotonus.  At  the  positive  pole,  the  irritability  of  the  nerve 
is  diminished,  while  at  the  negative  it  is  excited  and  more  sus- 
ceptible to  stimulation.  The  condition  at  the  positive  pole  is 
called  anelectrotonus^  and  that  at  the  negative  catelectrotonus.  The 
positive  pole  is  known  as  the  anode  ;  the  negative,  the  cathode^  and 
these  give  the  name  to  the  states  described.  A  nerve  is  said  to 
be  tetanized  when  the  muscle  supplied  is  thrown  into  a  state  of 
permanent  tetanic  contraction  by  a  rapidly  intermittent  current. 
The  passage  of  a  number  of  these  shocks  for  some  time  will 
diminish  the  irritability  of  the  nerve  to  such  an  extent  that, 
finally,  there  will  be  no  further  response.  As  an  ascending  cur- 
rent causes  a  greater  irritability  in  a  nerve  than  a  descending  one ; 
a  descending  one  depresses  excitability.  The  stimulus  is  felt  at 
the  negative  pole  when  the  current  commences,  and  when  it  is 
broken  it  is  felt  at  the  positive  pole.  A  shock  is  felt  at  the 
opening  of  the  weak  currents  ;  with  moderately  strong  ones  it  is 
felt  both  at  the  opening  and  the  closure.  With  very  strong 
currents,  it  is  impossible  to  tell  the  points  of  sensation,  as  the 
power  of  the  nerve  Is  Impaired."  The  action  upon  involuntary 
muscles  is  less  than  upon  the  voluntary,  and,  as  regards  the  latter, 
it  is  the  same,  or  nearly  so,  as  long  as  the  integrity  of  their  im- 
mediate nerve  supply  is  concerned. 

Degenerations  and  atrophies  of  muscles  interfere  to  a  consid- 
erable extent  with  their  susceptibility  to  electric  currents ;  hence, 
it  is  better.  In  diseased  conditions,  to  pass  the  current  through  the 
nerve  trunk  which  supplies  them.  The  faradic  current 
has  but  a  local  effect,  the  deeper  muscles  and  nerves 
escaping. 

When  a  metallic  or  sponge  electrode    is  applied  to  the  mois- 


3S  DENTAL  MEDICINE. 


tened  skin,  a  pricking  sensation  follows,  attended  with  redness 
and  tingling,  and  this  impression  on  the  cutaneous  nerves  and 
muscles  is  known  as  electro-muscular  sensibility.  The  galvanic 
current  occasions  a  sensation  of  warmth,  like  that  produced  by  a 
local  stimulant,  such  as  a  mustard  plaster,  and  when  the  faradic 
current  is  applied  to  the  dry  skin,  or  when  the  electrodes  are  but 
lightly  applied,  there  is  produced  a  sensation  of  pain,  and  the  pain 
is  the  greater  when  caused  by  rapidly  succeeding  shocks  than  by 
slow  ones. 

The  galvanic  current  causes  deeper  impressions  than  the 
faradic,  and  also  electrolytic  changes  different  from  the  faradic, 
producing  absorption  and  changing  the  structure  of  the  different 
tissues,  and  beneficial  results  have  resulted  from  its  application  in 
diseases  of  the  brain.  The  physical  effects  of  the  galvanic  cur- 
rent upon  the  sympathetic  nerve  are  dilatation  followed  by  con- 
traction of  the  pupil,  diminished  frequency  of  the  pulse,  and  a 
lowering  of  the  tension  of  the  carotid  arteries.  When  electricity 
is  used  for  the  purpose  of  diagnosis,  the  existence  of  local  tender- 
ness, exalted  sensibility,  anaesthesia,  paralysis,  diseases  of  the 
brain,  spinal  cord,  etc.,  may  be  ascertained.  It  has  also  been 
used  to  determine  the  question  of  doubtful  death,  whether  certain 
affections  are  recent  or  of  long  standing,  and  to  detect  malinger- 
ing. As  various  nervous  diseases  are  associated  with  the  loss  of 
such  functions  of  muscles  as  contraction  and  sensation,  or  the 
reverse,  electricity  determines  the  extent  of  such  changes. 

When  employing  the  electric  current,  the  anatomy  of  the  part 
affected  should  be  well  understood  ;  for  example,  for  neuralgia  of 
the  fifth  pair  of  nerves  one  pole  should  be  applied  as  near  as  pos- 
sible to  the  point  of  exit  of  the  nerve  from  the  cranium,  and  the 
other  pole  to  the  remote  parts  of  distribution. 

Galvanism  and  faradism  are  employed  for  the  relief  of  pain 
and  spasm  to  improve  the  nutritive  processes,  and  to  restore  de- 
ficient muscular  power,  to  stimulate  sensation  in  nerves,  to  stim- 
ulate secretion,  to  influence  circulation,  to  cause  absorption  of 
fluids,  to  bring  about  the  absorption  of  morbid  growths  and  de- 
posits, to  induce  sleep,  and  in  surgery,  in  the  form  of  the  galvanic 
cautery.       The  galvanic   current  is   considered   to  be   the  most 


THERAPEUTICS  OF  ELECTRICITY.  39 

useful  for  the  mediate,  and  the  faradic  current  for  the  immediate 
application,  the  former  proving  serviceable  in  all  forms  of  neural- 
gia, and  especially  in  facial  neuralgia,  and  the  latter  in  headaches, 
especially  those  of  a  rheumatic  nature. 

Galvanism  is  also  employed  with  advantage  in  sciatica,  spinal 
irritation  and  hysteria,  also  tumors,  such  as  aneurisms  and  goitre, 
these  morbid  products  being  dispersed  by  connecting  the  two 
poles  of  a  galvanic  battery  with  needles  which  are  thrust  into 
the  morbid  growth  and  generate  a  process  known  as 
electrolysis.  In  such  operations  bubbles  of  hydrogen  gas 
are  disengaged  at  the  negative  pole,  which  separate  mechanic- 
ally the  adjacent  tissues,  breaking  them  up  in  such  a  manner 
that  the  disintegrated  particles  may  be  taken  up  by  the  circula- 
tion. Oxygen  is  disengaged  at  the  positive  pole,  which  forms 
an  acid  with  certain  elements  of  the  tissue,  and  the  albumen 
is  coagulated,  forming  a  clot  if  this  occurs  in  a  cavity  filled  with 
blood. 

For  obtunding  sensitive  dentine  and  controlling  peridental  in- 
flammation by  electrolysis.  Dr.  F.  McGraw  suggests  the  follow- 
ing method:  "To  a  12  per  cent,  solution  of  cocaine  add  an 
equal  amount  of  absolute  alcohol.  In  connection  with  this  use 
the  galvanic  current,  varying  the  power  as  the  needs  of  each  case 
may  indicate."  The  method  of  application  is  as  follows  : 
"After  applying  the  rubber-dam,  wet  a  pledget  of  cotton  in  the 
solution  ;  place  it  in  the  cavity  of  the  tooth  ;  press  the  point  of 
the  positive  pole  on  to  the  cotton,  and  the  negative  pole,  with 
sponge  attachment,  to  the  cheek,  turning  on  the  current.  An 
application  of  three  minutes,  with  an  interval  of  like  duration, 
and  then  another  three-minute  application,  is  sufficient  in  the 
majority  of  cases,  although  it  is  occasionally  necessary  to  make 
the  third  application.  Then  dry  the  cavity  thoroughly  and  begin 
excavating."  In  case  of  peridental  inflammation  use  a  stronger 
current,  which  tetanizes  the  vessels  and  causes  a  diminished  flow 
of  blood  to  the  parts  and  thus  lessens  congestion.  The  same 
current  longer  continued  will  cause  electrolytic  decomposition. 
"  The  medicinal  agents  he  uses  for  peridental  inflammation  and 
for  blind   abscesses  are   a  saturated   solution   of  the  chloride  of 


40  DENTAL  MEDICINE. 


sodium  seven  ounces,  tincture  of  ergot,  one  ounce.  The  treat- 
ment of  blind  abscesses  requires  a  stronger  battery  power  in  order 
to  obtain  the  full  effect  of  the  electrolysis.  Dr.  Weeks 
has  used  this  method  successfully  in  the  painless  removal  of 
pulps.     (See  Cataphoresis.) 

•  Galvano-Cautery. — For  surgical  operations,  as  a  substitute  for 
the  knife  or  ecraseur,  a  platinum  wire  is  placed  between  the  poles 
of  a  powerful  battery,  the  wire  being  adjusted  in  a  handle,  which 
in  a  few  minutes  becomes  red  hot,  and  is  especially  serviceable 
for  operations  in  deep  cavities  where  it  would  be  impossible  to 
use  the  knife,  the  application  of  such  a  galvanic  cautery  being  un- 
attended by  pain  or  hemorrhage.  The  Galvano-Cautery  consists 
of  a  platinum  wire  loop  heated  by  passing  a  current  of  electricity 
through  it,  the  heat  being  maintained  as  long  as  the  current 
passes.  Such  an  appliance  will  cut  through  the  tissue  to  which 
it  is  applied  without  causing  much  hemorrhage. 

Electric  portable  mouth  lamps  are  also  employed  for  illuminat- 
ing the  mouth  and  examining  the  teeth,  and  carious  cavities  in 
them. 

Strong  currents  of  electricity  should  not  be  applied  to  the 
head,  nor  its  use  be  persevered  in  for  more  than  fifteen  minutes 
at  a  time. 

Electro-magnetism  has  been  employed  for  relieving  pain  dur- 
ing the  extraction  of  teeth,  one  pole  of  an  ordinary  battery  being 
attached  to  the  forceps  and  the  other  to  a  handle  which  is  grasped 
by  the  patient.  The  susceptibility  to  the  current  is  first  as- 
certained by  the  patient  holding  both  the  forceps  and  the  handle 
in  his  hands,  and  a  feeble  shock  applied,  which  is  gradually  in- 
creased until  the  sensation  is  felt  at  or  just  beyond  the  elbows, 
when  the  current  is  somewhat  reduced  in  power.  After  the 
gum  has  been  lanced,  the  connection  is  made  as  before  de- 
scribed, by  the  patient  holding  the  handle  and  the  operator 
the  forceps  in  contact  with  the  tooth  to  be  removed,  the 
handles  of  the  instrument  being  isolated,  when  the  operation  is 
at  once  completed.  Great  diversity  of  opinion,  however,  exists 
as  to  the  efficiency  of  this  method,  which  has  its  advocates  and 
opponents. 


INCOMPATIBILITY.  41 


INCOMPATIBILITY.* 

*'  Incompatibility  gives  rise  to  many  dangers  which  may  in  a 
great  measure  be  avoided  by  the  use  of  the  utmost  simphcity  in 
prescribing.  '  The  tendency  of  the  present  age  is  toward  mono- 
rather  than  poly-pharmacy,  and  prescriptions  with  the  orthodox 
adjuvans  and  corrigens  are  less  frequently  seen  than  formerly.' 
(Piffard.) 

"  This  subject  can  only  be  glanced  at  here.  The  following 
simple  rules  may  help  the  burdened  memory  of  the  practitioner: — 

"  Never  use  more  than  one  remedy  at  a  time,  if  one  will  serve 
the  purpose. 

"  Never  use  strong  mineral  acids  in  combination  with  other 
agents,  unless  you  know  exactly  what  reaction  will  ensue.  They 
decompose  salts  of  the  weaker  acids  and  from  ethers  with 
alcohol. 

*'  Select  the  simplest  solvent,  diluent  or  excipient,  you  know 
of,  remembering  that  the  solvent  power  of  alcohol  and  water, 
for  their  particular  substances,  decreases  in  proportion  to  the 
quantity  of  the  other  added. 

"  Never  combine  Free  Acids  with  hydrates  or  carbonates. 

"  Generally  do  not  combine  two  or  more  soluble  salts. 

"The  following  more  or  less  insoluble  salts  will  be  formed 
whenever  the  materials  of  which  they  are  composed  are  brought 
together  in  solutions ;  the  Hydrates,  Carbonates,  Phosphates, 
Borates,  Arseniates  and  Tannates  of  most  earthy  and  heavy 
metals  and  alkaloids,  and  the  metallic  Sulphides  ;  the  Sulphates 
of  Calcium,  of  Lead  and  of  the  subsalts  of  Mercury :  the 
Chlorides,  Iodides  and  Bromides  of  Bismuth,  Silver,  Lead  and 
subsalts  of  Mercury ;  the  Iodides  of  Quinine,  Morphine  and 
most  alkaloids. 

"  Alkalies  precipitate  the  alkaloids  and  the  soluble  non-alkaline 
metallic  salts,  and  (as  also  metallic  Hydrates  and  Carbonates) 
neutralize  free  acids. 

"  Silver  Nitrate^  Lead  Acetate^  Corrosive  Sublimate^  Potassium 
Iodide  should  nearly  always  be  prescribed  alone.     The  first  with 

*  S.  O.  L.  Potter,  M.  D. 


42  DENTAL  MEDICINE. 


Creasote  forms  an  explosive  compound,  yfconite  should  never  be 
given  in  any  vehicle  except  water. 

"  Silver  Nitrate^  and  Lead  Acetate  and  Subacetate^  although  in- 
compatible with  almost  everything,  may  be  combined  with 
Opium  :  the  latter  forming  with  Opium  a  compound  which,  al- 
though insoluble,  is  therapeutically  active  as  a  lotion. 

"  Corrosive  Sublimate  is  incompatible  with  almost  everything, 
and  should  be  given  in  Simple  Syrup ;  even  the  Compound  Syrup 
of  Sarsaparilla  is  said  to  decompose  it. 

"  Tannic  Acid^  and  substances  containing  it,  are  incompatible 
with  albumen  and  gelatin.  Tannic  Acid^  Iodine  and  the  soluble 
Iodides  are  incompatible  with  the  alkaloids  and  substances  contain- 
ing them,  and  with  most  soluble  metallic  salts.  Vegetable  In- 
fusions are  generally  incompatible  with  metallic  salts. 

"  Glucosides^  such  as  Santonin  and  Colocynthin,  should  not  be 
prescribed  with  free  acids  or  Emulsin. 

"  Dangerous  Compounds^  because  poisonous,  are  :  Potassic  Io- 
dide with  Potassic  Chlorate ;  Hydrocyanic  acid  or  Potassium 
Cyanide  with  metallic  Hydrates,  Carbonates,  Sub-nitrates  or  Sub- 
chlorides,  as  Bismuth,  Carbonate  or  Nitrate  or  Calomel. 

"  Explosions  would  result  from  the  combination  of  powerful 
oxidizers  with  readily  oxidizable  substances,  as  Potassium  Chlo- 
rate or  Permanganate  with  Tannin,  Sugar,  Sulphur,  Sulphides, 
Vegetable  powders.  Glycerine,  Alcohol,  Tinctures  or  Ether." 


POSOLOGICAL   TABLES. 


43 


TABLE  OF  THE  DOSES  OF  MEDICINES. 

GIVING  THE  DOSES  OF  OFFICIAL  AND  UNOFFICIAL  DRUGS  IN 
BOTH  THE  ENGLISH  AND  METRIC  SYSTEMS. 


Compiled  Specially  for  Gould's  Pocket  Dictionary^  Fourth  Edition^  and 
the  Physician  s  Visiting  List. 

By  a.  a.  Stevens,  A.M.,  M.D., 

LECTURER    ON    PHYSICAL   DIAGNOSIS    IN    THE    UNIVERSITY    OF    PENNSYLVANIA. 


The  Doses  given  are  for  adults ;  for  children,  either  Young's  or  Cowling's  rule 
is  sufficiently  accurate  for  most  drugs,  except  narcotics  and  cathartics.  Accord- 
ing to  Young's  rule  the  dose  is  obtained  by  dividing  the  age  by  12  plus  the  age. 

3 
Thus,  for  a  child  of  3  years,  ^  =  J^  or  \.     Cowling's  rule  is  to  divide  the 

number  of  the  next  birthday  by  24.  Thus,  for  a  child  5  years  old,  ^\  ^  %• 
Of  narcotics,  like  opium,  not  more  than  one-half  of  this  proportion  should  be  pre- 
scribed, while  of  cathartics  this  dose  may  be  exceeded  two  or  three  times. 

For  subcutaneous  administration  the  dose  should  be  about  one-half  of  that  given 
by  the  mouth ;  and  for  rectal  administration  about  twice  the  amount  given  by  the 
mouth. 


Remedies. 


Absinthin 

Acetal, 

Acetanilide  (see  Antifebrin). 

Acetone, 

Acid.  acet.  dil., 

benzoic, 

boric, 

camphoric, 

carbolic, 

cathartic, 

chrysophanic 

citric,     

fluoric,  dil., 

gallic, 

hydriodic,  syrup,      .    .    . 

hydrobrom.  dil.,   .... 

hydrochlor.  dil.,    .... 

hydrocyan.  dil.,    .... 

lactic, 

nitric  dil 

nitro-hydrochloric,   .    .    . 

nitro-hydrochloric  dil.,     . 


Dose.     Apoth. 


gr- 

m 

gr- 


m 

gr- 

k 


gr- 

m 


15-30  • 

5-iS  ■ 
60-90  . 

5-15  • 

5-15  • 

10-20  . 

X-i  . 

4-5    • 

yk-\o . 

10-30  . 

15-20  . 

3-15  • 

'A-z  ■ 
20-32 

3-10 . 

1-5   • 

15-30  • 

3-15  • 

I-IO  . 

5-20 . 


Dose.     Metric. 


1.000-2.000 
6.000- 1 2.000 

0.333-1.000 

4.000-6.000 

0.333-1.000 

0.333-1000 

0.666-1.333 

0.016-0.066 

0.250-0.333 

0.008-0.666 

0.666-2.0OO 

1.000-1.333 

o.  200- 1. 000 

2.000-12.000 

I-333-8000 

0.200-0.666 

0.066-0.333 

I.000-2.000 
0.200-1.000 
0.066-0.666 
0.333-1-333 


44 


DENTAL  MEDICINE. 


Remedies. 


Acid,  oxalic,     .... 

phosphoric  dil.,    .    . 

picric, 

salicylic, 

sulphuric  arom.,  .    . 

sulphuric  dil.,  .    .    . 

sulphurous,  .... 

tannic, 

tartaric, 

Aconiti,  abst.,  .... 

extr., 

extr.  fld., 

tinct., 

tinct.  Fleming's,  .    . 

Aconitine, 

Adonidin, 

Agaricin, 

Agathin 

Ailanth,  ext.  fld.,     .    . 

tinct., 

Alantol, 

Allii,  syrup 

Aloe,  purif.,      .... 

ext.  aquos.,   .... 

pilulse, 

pilulse,  et  asaf.,    .    . 

pilulae,  et  ferri,     .    . 

pilulas,  et  mast.,   .    . 

pilulas,  et  myrrh.,     . 

pulvis,  et  Canellae,  . 

tinct,, 

tinct.,  et  myrrh.,  .    . 

vinum, 

Aloin, 

Alumen, 

Alumini  hydras.,  .  . 
Ammoniae,  aqua,  .    .    . 

mist., 

spiritus, 

spiritus  arom.,  .    .    . 

spiritus  foetid.,  .  .  . 
Ammonii  acetat.,  liquor, 

benzoas, 

bromid., 

carbonat., 

chlorid., 

iodid., 

phosphat.,     .... 

picrat., 

valerian., 

Amygdalae  amar.  aqua, 

amar.,  mist.,      .    .    . 

amar.,  oleum,  .  .  . 
Amyl  nitris,  .... 
Amylene  hydrat.,     .    . 


Dose.     Apoth. 


m  5-30 

gr-  1-5 
"      5-20 

m  5-15 
"  5-15 
"  5-30 

gr.  l-io 
"    10-20 

"  X-'A 
"    i-K 

"     »-5 

"    %-2 

gr-iriWiT 
"  tV-X 
"  X-'A 
"     5-10 

m,.  10-60 
"  10-32 

gr.     i 
gr-     1-5 

"  y2-3 

No.  1-3 
"  2-5 
"  1-3 
"  1-2 
"     2-5 

gr.    5-20 

"  A-2 
"    1-2 

gr-     1-3 
"    10-15 
"      3-15 

m  5-30 
^  4-8 
m  5-30 
"  15-60 

3  A-l 
"    1-8 

gr-  5-»S 

"  5-20 

"  3-JO 

"  1-20 

"  2-10 

"  5-20 

"  %-A 

"  1-5 

.3  2-4 

«  2-4 

mx-i 

"  X-i 
3  ^-'A 


Dose.     Metric. 


0.008-0.016 
0.333-2.000 
0.066-0.333 

0.333-I-333 

0.333-1.000 
0.333-1.000 
0.333-2.000 
0.066-0.666 
0.666-1.333 
0.016-0.033 
0.0II-0.022 
0.033-0.133 
0.066-0.333 
0.044-0.133 
0.000335-0.0013 
0.006-0.016 
0.016-0.033 
0.333-0.666 
0.666-4.000 
0.666-8.000 
O.OIO 

4.000- 1 6.000 

0.066-0.333 

0.033-0.200 


0.333-I-333 
2.000-8.000 
2.000-8.000 
4.000-8.000 
0.066-0.200 
0.666- 1. 000 
0.200-1.000 
0.333-2.000 
16.000-32.000 
0.333-2.000 
1 .000-4.000 
2.000-4.000 
4.000-32.000 
0.333-1000 

0.333-1.333 
0.200-0.666 
0.066-1.333 
0.133-0.666 

0.333-1.333 
0.008-0.033 
0.066-0.333 
8.000-16.000 
8.000-16.000 
0.0165-0.066 
0.0165-0.066 
4.000-6.000 


POSOLOGICAL   TABLES. 


45 


Remedies. 


Amylum  iodatum,    .... 

Analgen, 

Anarcotin, 

Anemonin, 

Anisi,  oleum 

spiritus 

Antifebrin, 

Antimonii  oxid., 

pil.  comp., 

pulv., 

sulpliid,  pur., 

sulphuret, 

et  potas.  tart. ;  diaph., 

et  potas.  tart.;  emet.,  .    . 

vin., 

Antipyrin, 

Antispasmin, 

Antitoxin  (diphtheria),    .    . 

Apiol 

Apiolin, 

Apocodein  hydrochl 

Apocynin, 

Apocyn.  cannab.,  ex.  fi., 

Apolysin, 

Apomorph.  hydrochl.,      .    . 
Arbutin  (see  Uva  Ursi).  .    . 

Arecolin, 

Argenti  iodid., 

nitras, 

oxid., 

Arnicse  rad.,  ext.,     .... 

rad.,  ext.  fld., 

flc,  tinct., 

rad.  tinct., 

Arsenos.,  acid, 

acid.,  liquor, 

Arseni,  liquor,  brom.,      .    . 

bromid., 

iodid., 

et  hydrarg.  iod.,  liq.,  .    . 
Asafetida, 

mist., 

pilulje, 

tinct., 

Asaprol, 

Asparagin, 

Asparagus,  fl.  ex.,    .... 

Aspidospermin, 

Atropin  sulph.  (see  Bellad.). 
Aspid.,  ext.  fl., 

oleores., 

Aurantii  amar.,  ext.  fl.,   .    . 

amar.,  tinct., 

dulcis,  tinct., 

Auri  chlorid, 


Dose.     Apoth. 


Dose.     Metric. 


gr-  3-30  ■ 
"      2-5     . 

"      1-3 

m  i-s 
3  1-2  . 

gr.  2-10  . 
"  1-2  . 
No.   1-3 

gr.     1-5     • 

"    %-i     . 

"    'A-3    ■ 

"  ^'A  ■ 
"    1-2 

m  1-5 

gr.     5-10  . 

"  -X  ■ 
c.c.   5-10  . 

m  3-s 

gr.  iA-3  ■ 
"  i-'X  • 
"  H-A  ■ 

in  10-30 . 

gr.  5-20  ■ 
"   -jV-tV  • 

"  ^-tV  ■ 
"  X-i  ■ 
I-3X. 

"      1-3 

m  s-20. 
"  5-30  . 
"  s-30  • 

gr.^VTV- 

m  2-10. 
"  1-4  . 

gr-  ^V-tV  ■ 

m  2-10. 

gr.  5-20  . 
3  4-8  . 
No.  1-4    . 

Ttl  30-60  . 

gr.  3-6  . 
"      5-10  • 

3  A-^  ■ 
3     1-2    . 

gr.  15-60  . 

3^/2-^    ■ 

"  1-2  . 
"        1-2      . 

gr-  -sV- sV  • 


0.200-2.000 
o- 133-0-333 

0.066-0. 2Q0 
O.O4O-0. 100 
0.066-0.333 
4.000-8.000 
0.133-0.666 
0.066-0.133 

0.666-0.333 
0.016-0.066 
0.033-0.200 
0.003-0.008 
0.066-0.133 
0.066-0.333 
0.333-0-666 
O.OII-O.O16 

2.000-0.333 
0.100-0.200 
0.060-0080 
0.016-0.333 
0.666-2.000 

0-333-I-333 
0.002-0.006 

0.003-0.004 
0.016-0.066 
0.011-0.016 
0.033-0.133 
0.066-0.200 

0.333-1.333 
0.333-2.000 
0.333-2-000 
0.001-0.003 
0.133-0.666 
0.066-0.266 
0.001-0.004 
0.003-0.006 
0.133-0.666 

0.333-1.333 
16.000-32.000 

2.000-4.000 
0.200-0.400 
0.300-0.600 
2.000-4.000 


4.000-8.000 
1.000-4.000 
6.C00-8.000 
4.000-8.000 
4.000-8.000 
0.00 1 3-0.002 


46 


DENTAL  MEDICINE. 


Remedies. 


Auri,  et  sod.  chlorid,  .... 
Bals.  tolutan,  syr., 

tolutan,  tinct., 

Baptis.,  ext., 

ext.  fld., 

tinct., 

Basham's  mixture, 

Barii  chlor., 

Beeberin,      

Belladon.,  abst., 

ext.,  ale, 

fol.  ext.  fl., 

rad.,  ext.,      

rad.,  ext.  fld., 

tinct., 

Atropin  sulph., 

Benzanilid, 

Benzoin,  tinct., 

tinci.  comp., 

Benzo-napthol, 

Benzosol  (see  Guaicol  Benzoat). 
Berber,  ext.  fld.,      

tinct., 

Berberin, 

Betaiiaphtol, 

bismuth 

Betol, 

Bismuth  et  ammon.  cit,      .    . 

loretinate, 

salicylat., 

subcarb., 

subcarb.  nitr,, 

subgallat., 

Bold.,  tinct., 

Brayera, 

ext.  fl., 

infus., 

Bromalin, 

Bromoform, 

Bromol, 

Bryon.,  tinct., 

Brucina  (see  Nux  Vom.).  .  . 
Buchu,  ext.  fl., 

infus., 

Butyl  chloral  hydrate,  .  .  . 
Cactii  grandiflor.,  ex.  fl.,  .  . 
Cafi"ein, 

citrat., 

Cajuput,  oleum, 

Calam.,  ext.  fl., 

Calc.  bromid., 

carb.  precip., 

chlorid., 

glycerophosphat.,     .... 

hypophosph., 


Dose.    Apoth. 


3        1-2      . 

ill  10-30 . 

gr.     i-io  . 

tn  2-20  . 

"   5-30  • 

3     2-6    . 

gr-  t\-/2  ■ 

"   ^-\  ■ 

"  i^'A  ■ 

m  3-6  . 

gr.  %-%  . 

m  1-3  . 
"  1-20  . 

or        1 J 

gr-  i^oSIS 
"    10-15  • 

3  'A-i  . 
"  Yz-^  . 

gr.    5-8    • 

m  5-30  . 
"  10-60 . 

gr.   i-io  . 

"  3-6    . 

"  10-15  • 

"  4-8    . 

"  1-5    • 

"  5-10  ■ 

"  5-15  • 

"  10-30  . 

"  10-60  . 

"  5-15  • 

m  5-8  ■ 

•z  2-8  . 
«  2-8  . 
3        2-8     . 

gr.  30-60  . 

m  5-10  ■ 

gr.     1-2     . 

m  5-30. 
"  10-60  . 

gr.  5-20  . 

m  3-5     • 

gr.  1-5     • 

"  2-10  . 

m  i-s  . 
"  15-60. 

gr.  5-30  • 
"  5-20  . 
"    10-20  . 

"  2-5  . 
"   10-20  . 


Dose.     Metric. 


0.002-0.006 
4.000-8.000 
0.666-2.000 
0.066-0.666 

O.I33-I-333 
0.333-2.000 
8.000-24.000 

0.0065-0.032 
0.005-0.100 
0.006-0.066 
0.006-0.033 
0.200-0.400 
0.008-0.016 
0.066-0. 200 
0.066-1.333 

0.0005-0.001 
0.650-1.000 
2.000-4.000 
2.000-8.000 
0.333-0.520 

0.333-2.000 
0.666-4.000 
0.066-0.666 
0.200-0.400 
0.666-1.000 
0.260-0.520 
0.066-0.333 
0.333-0.666 
0.333-1.000 
0.666-2.000 
0.666-4.000 
0.333-1.000 

0.333-0.533 
8.000-32.000 
8.000-32.000 
64.000-256.000 
2.000-4.000 
0.300-0.650 
0.166-0.133 
0.333-2.000 

0.666-4.000 
16.000-64.000 

0.333-1.333 
0.200-0.333 
0.066-0.333 
0.133-0.666 
0.066-0.333 
1.000-4.000 
0.333-2.000 

0.333-1-333 
0.666-1.333 

0.133-0.333 
0.666-1.333 


POSOLOGICAL   TABLES. 


47 


Remedies 


Dose.     Metric. 


Calc.  iodid, 

lactophosph., 

phosph.  precip., 
Calx  chlorata, 

sulphurata, 
Cannabindon, 
Creta  preparat 

mist.,     .    . 

pulv.  comp 
Calx,  liq.,     .    . 

syr.,   .... 

syr.  lac.  phos., 
Calend.  tinct 
Calumba,  ext., 

ext.  fl.,  .    .    . 

tinct.,     .    .    . 
Camphora, 

aqua,      .    .    . 

spirit,     .    .    . 

Rubini  tinct., 

monob.,     .    .    . 
Cannabis  ind.,  ext., 

fluid,      .... 

tinct.,     .... 
Cannabin  tan 
Canthar.  tinct.. 
Capsicum 

ext.  fl.,       .... 

oleores.,     .... 

tinct., 

Carbo  animal,  purif.. 
Carbon  bisulph 
Cardam.  tinct., 

tinct.,  comp., 
Cari,  oleum, 
Caryophyl.  ol.,      .    . 
Cascara  sag.,  ext.  fl., 
Cascarill.  ex.  fl.,  .    . 

Cascarin, 

Castan.  ext.  fl.,     .    . 
Catechu, 

tinct.  com 

Cerii  oxal., 

Chenopod.  ol.,      .... 
Chimaph.  ex.  fl.,  .    .    .    . 
Chinoidin  (see  Cinchona). 
Chinolin  tartras, 
Chirat.,  ext.  fl., 

tinct.,     .    .    . 
Chloral,     .    .    . 
Chloralamid, 
Chloralose, 
Chloramid, 
Chlorobrom 
Chloroform, 


0.066-0.200 
0.200-0.666 
0.133-0.666 
0.200-0.400 
0.006-0.033 
0.033-0.066 

0-333-I-333 
8.000-16.000 
0.333-4-000 
16.000-64.000 
2.000-8.000 
4.000-8.000 
1.000-2.000 
0.200-0.666 
0.333-2.000 
2.000-8.000 
0.066-1.333 
4.000-16.000 

0-333-I-333 
o- 133^-333 
0.066-0.333 
0.0 1 1-0.033 
0.066-0.333 
1.000-2.000 
0-333-0-666 
0.066-0.666 

o- 133-0.333 
0.333-2.000 
0.066-0.333 
0.666-2.000 
0.666-4.000 
0.033-0.066 
4.000-8.000 
4.000-8.000 
0.066-0.333 
0.066-0.333 
0.666-1.333 
4.000-8.000 
0.133-0.200 
2.000-8.000 
0.066-2.000 
0.666-4.000 
0.066-0.333 
0-333-0-666 
2.000-8.000 

0-333-I-333 
1.000-2.000 
1.000-4.000 
0.066-1.000 
0.666-2.000 
0.133-0.400 
1.333-2.000 
32.000 
OI33-I-333 


48 


DENTAL  MEDICINE. 


Remedies. 


Chloroform,  mist.,   .... 

spirit, 

tinct.  comp., 

et  morph.,  tinct.,  .... 

Chlorodyne, 

Chlori,  aqua, 

Chrysarobin, 

Cimicifugae,  ext.  fl.,     ... 

tinct., 

Cinchona, . 

ext., 

ext.  fl., 

tinct., 

tinct.  conip., 

tinct.,  Huxham's,  .  .  . 
Cinchonidin,  sulph.,  .  .  . 
Cinchonin,    

salicylat., 

sulph., 

Chinoidin, 

Quinidin,  sulph., 

Quinin, 

arsen., 

bisulphas, 

hydrobromas, 

hydrochloras, 

sulphas, 

valerianate, 

tinct.,  Warburg's,  .  .  . 
Cinnamomum, 

oleum, 

spirit, 

tinct., 

pulv.  arom., 

ext.  arom.  fl., 

Cocain  (see  Erythroxylon). 

Cocillan,  ex.  fl., 

Codein  (see  Opium).  .  .  . 
Cocculus,  ex.  fl.,      .... 

tinct., , 

Picrotoxin, 

Colchici  rad.  ext.,    .... 

rad.  ext.  fl., 

sem.  ext.  fl.,      

tinct., 

rad.,  vin., 

sem.,  vin., 

Colchicin, 

Colocynth,  ext., 

ext.  comp., 

Pill  cath.,  CO., 

Condurango,  ext.  fl.,  .  .  . 
Conii  abst., 

ext.  ale, 

ext.  fl., 


Dose.     Metric. 


k 


gr. 

m 
g'- 
m 

5 


gr- 


gr. 

gtt. 

m 

3 

gr- 

m 


gr- 

m 


gr- 
No, 

3 

gr- 

m 


1-2  . 
10-60  . 
20-60  . 

5-10. 
10-30  . 
10-20  . 

2-20  . 

5-30. 

5-30. 
10-60  . 

1-5 
10-60  . 

y2-2  . 

1-30  . 
1-30  . 
1-30  . 
1-30  . 
1-30  . 
1-30  . 
1-20  . 

i-I  • 
1-20  . 
1-20  . 
1-20  . 
1-20  . 

1-3    - 

5-20  . 

1-5 

5-30- 

y2-2  . 

10-30  . 

1-30 . 

20-30 . 

1-3  • 
^2-15  ■ 

2-5   • 

1-5   • 

10-30. 

5-15  • 
5-30^- 

K-2      . 
5-10. 

1-3 
1-2    . 

y2-2  . 

»-5  ■ 
2-5    ■ 


4.000-8.000 
0.666-4.000 
I  •333-4000 

0-333-0-666 
0.666-2.000 
0.666-1. 133 

0.333-2.0CO 
0.333-2.000 
0.666-4.000 
0.066-0.333 
0.066-4.000 
2.000-8.000 
2.000-8.000 
2.000-8.000 
0.066-2.000 
0.066-2.000 
0.066-2.000 
0.066-2.000 
0.066-2.000 
0.066-2.000 
0.066-1.333 
0.0 1 1-0.066 
0.066-1.333 
0.066-1.333 
0.066-1. 133 
0.066-1.333 
0.066-0. 200 
16.000-32.000 

0.333-I-333 
0.066-0.333 
0.333-2-000 
2.000-8.000 
0.666-2.000 
0.066-2.000 

I-333-I-000 

0.066-0.200 
0.1 33- 1. 000 
0.00 1 -0.00 1 5 
0.033-0. 100 

0-133-0-333 
0.066-0.333 
0.666-2.000 
0.333-1.000 
0.333-2.000 
0.0005-0.0013 
0.033-0.133 
0-333-0-666 

4.000-8.000 
0.033-0.133 
0.066-0.333 
0-133-0-333 


POSOLOGICAL   TABLES. 


49 


Remedies, 


Dose.     Metric. 


Conii  tinct 
Conin,  .  . 
Convallar,  ex 

ext.  fl.,  .    .    . 

infus.,    .    .    . 
Convallamarin, 
Convolvulin, 
Copaiba, 

massa, 

mist,  comp., 

oleum, 

resin.,    .    .    . 
Coriand.  ol., 
Coinus,  ext.  fl., 
Cornutin, 

Cotarnin  hydrochlor.. 
Goto,  tinct., 
Cotoin,  .    . 
Creosotal, 
Creosotum, 

aqua 
Creosot.  carb., 
Croci,  tinct., 
Croton  chloral, 
Cubeba, 

ext.  fl., 

oleores., 

oleum, 

tinct.,     . 

trochis., 
Cup.  acetas, 

ammon 

arsenit, 

sulphas. 
Curare, 
Curarin, 

Cusso  (see  Brayera) 
Cypriped.  ex.  fl., 
Damianse,  ext., 

ext.  fl., 

Daturin  (see  Stramonium).  .  . 
Derma.tol  (see  Bismuth  subgall.) 
Digitalis 

abstr., 

ext., 

ext.  fl., 

infus., 

tinct., 

Digitalin  ("  German  "  Merck), 

("  French "  Merck),    .    .    .    , 

(Nativelle), 
Digitoxin, 
Dionin, 

Dioscor.  ex.  fl., 
Diuretin, 
4 


O.CX)I-0.002 
0.133-0.666 
0.133-0.666 
16.000-64.000 
0.050-0.066 
0.060-0.130 
0.666-4.000 
0.333-2.000 
4.000-16.000 
0.666-1.000 
0.066-0.333 

o.  133-0-333 
0.666-4.000 
0.005-0.01 1 
0.018-0.200 
0.066-1.000 
0.066-0.266 

0.333-2.000 

0.066-0. 200 
4.000-16.000 

0.333-2.000 

4.000-8.000 
0-333-0-666 
0.666-4.000 
0.333-2.000 
0-333-I-333 
0-333-I-333 
4.000-8.000 

0.006-0.016 
0.0 1 1-0.066 

0.00067 
0.016-0.033 
0.002-0.01 1 

0.00067-0.0015 

0.666-2.000 
0.133-0.666 
0.666-4.00Q 


0.033-0.133 

0.016-0. 133 

0.0 1 1-0.033 

0.066-0.200 

4.000-16.000 

0.333-2.000 

0.001-0.002 

0.00026-0.00067 

0.00065-0.00 1 

0.00033-0.00065 

0.033-0.066 

1.000-2.000 

0.666-1.333 


50 


DENTAL  MEDICINE. 


Remedies. 


Donovan's    sol.    (see    Arseni    et 

hydr.  iod.  liq.) 

Dover's  powd.  (see  Ipecac).  . 

Dracont.  ex.  fl., 

Dubois.,  ext., 

tinct., 

Duboisin  sulph., 

Dulcamar.  ex.  fl., 

Elaterin, 

trit, 

Emetin, 

Eosote,      

Ergota, 

ext., 

ext.  fl., 

vin., \    .    .    . 

Ergotin, 

Erigeron  ol., 

Eriodyct.,  ext., 

ext.  fl.,       

Erythrol  tetranitrate,  .... 

Erythrox.  ex.  fl 

Cocain, 

hydrochloras, 

Eserin  (see  Physostig.).  .    .    . 
Ether  fort., 

spirit.,    . 

spirit,  comp., 

spirit,  nit., 

Ethyl  bromid., 

Eucalyp.  ex.  fl., 

oleum, 

tinct., 

Euchinin, 

Euonym.,  ext., 

Euonymin, 

Eupator.  ex.  fl., 

Euphorin, 

Exalgin, 

Fel.  bov.  inspis., 

bovis  purif., 

Ferratin, 

Ferropyrin, 

Ferrosomatose, 

Ferri  dialys., 

dialys.  liq., 

redact., 

Fer.  acetat.,  tinct., 

albuminas, 

amar.  vin., 

arom.  mist., 

arsen., 

benzoas, 

bromid., 

bromid.,  syr., 


Dose.     Apoth. 


g 


m  30-60  . 
m  5-20. 

ar       1         I 
g"^-  TffT5-5Tr 

1        1 
'SJS~J1  ■ 

"  -h-H  ■ 

"     3-5    • 
"   10-60  . 

m 15-60  . 
3  1-4  . 
2-8  . 

5-15  ■ 
2-5  • 
5-60 . 


gr- 
in 

gr- 

m 

gr-  'A 

3 

gr 


-I 

_-2 

>i-2 

ys-2 


m 


k 


3 

gr- 


m 

gr- 


0-60 
0-60 
5-60 

0-00 
0-60 
5-10 

4-2 
5-30 

1-5 

y2-3 
0-60 
5-10 
2 


m 


5-J5 
5_io 

15-30 

5 
30-60 

5-15 
"  1-15 
gr.  1-5 
^  10-60 
gr.  10-20 
3      1-4 

gr-  x's-i 
..      1-5 


m 


»-5 

5-30 


Dose.     Metric. 


2.000-4.000 
O.OII-O.O16 

0-333-1-333 
0.00067-0.001 
4.000-8.000 
0.001-0.005 
0.008-0.033 
0.001-0.008 
0.200-0.333 
0.666-4.000 
0.100-0.533 
1.000-4.000 
4.000-16.000 

0-133-0-533 
0.333-1.000 

0-133-0.333 
1.000-4.000 
0.033-0.066 
2.000-8.000 
0.008-0.133 
0.008-0.133 

0.666-4.000 
O.666-4.OCO 
O-333-4OCO 
2.000-8.000 
0.666-4.000 
O.666-4.OCO 

0-333-0-666 
2.000-8.000 
1.C00-2.C00 
0.066-0.333 
0.033-0.200 
0.666-4.000 
0-333-O-666 
0.266-0.533 
0.333-1.000 
0-333-0-666 
1. 000-2. 000 

0-333 

2.000-4.000 
0-333- 1  oco 
0.066-1.000 

0.066-0.333 

0.666-4.000 

0.666-1.333 

4.000-16.000 
16.000-32.000 
0.006-O.OII 

0.066-0.333 
0.066-0.333 
0.333-2.000 


POSOLOGICAL   TABLES. 


.51 


Remedies. 


Fer.  carb.  sacch.,     .    .    . 

carb.,  massa.,    .... 

chlorid.,  liq.,     .... 

chlorid.  tinct.,  .... 

citrat., 

citrat.,  liq., 

citrat.,  vin., 

comp.,  mist.,     .... 

comp.,  pil., 

glycerophosphat.,     .    . 

hypophos., 

hypoph.,  syr.,   .... 

iodid., 

iodid.,  pil.,    .    . 

iodid.,  sac, 

iodid.,  syr., 

lactas, 

oxalas, 

oxid.  hydrat.,   .... 

phosphas, 

pyrophosph.,    .... 

sulph.  exsic,    .... 

sulph.  precip.,  .... 

valer 

et  amnion,  acet.  mist., 

et  am.  cit., 

et  am.  sulph.,  .... 

et  am.  tar 

et  quin.  cit.,      .... 

et  quin.  cit.  liq.,   .    .    . 

et  niang.  carb.  sac,     . 

et  mangan.  iodid.,  syr., 

et  mangan.  phos.  syr., 

et  pot.  tartr.,     .... 

quin.  strych.  phos.  syr., 

et  strych.  cit.,  .... 

Feniculi,  ol., 

Fowler's  sol., 

Frangulae,  ex.  fl.,  ... 
Galban.,  pil.  co.,      .    .    . 

Gallse,  tinct., 

Gambogia, 

Gaultheria,  ol.,  .... 
Gelsem.,  ex.  fl.,  .  .  .  . 
Gels^m.,  tinct.,  .... 
Gelsemin, 

(alkaloid), 

Gentian,  ext., 

ext.  fl., 

infus.  comp.,     .... 

tinct., 

Geosote,        

Geranii,  ex.  fl.,  .  .  .  . 
Glycyrrhiz.,  mist,  comp., 

pulv.  comp.,     .... 


Dose.     Apoth. 


Dose.     Metric. 


^O.' 


gr- 


0.133-0.666 
0.200-0.333 
0.133-0.666 
0.333-I-333 
o- 133-0-333 
0.333-0-666 
4.000-8.000 
16.000-32.000 

0.066-0.  zoo 
0-333-0-666 
4.000-8.000 
0.066-0.333 

0-333-0.666 
0.333-2.000 
0.066-0.200 
0.066-0.133 
16.000-32.000 
0.333-0.666 
0.066-0.333 
0.033-0.133 
0.033-0.133 
0.066-0.200 
8.000-24.000 

o- 133-0-333 
0.333-0-666 
0.333-1.000 
0.200-0.333 
0.333-1-000 

0-333-I-333 

0.666-2.000 

4.000 

0.333-0-666 

4.000-8.000 

0.066-0. 200 

0-133-0-333 
0.066-0.400 
2.000-10.000 

2.000-8.000 
0.066-0.266 
0.200-0.666 

0-333-I-333 
0.533-1.000 
0.001-0.003 
0.0005-0.002 
0.066-0.333 
0.333-4-000 
4.000-16.000 
2.000-4.000 

0.333-I-333 
1.000-2.000 
4.000-16.000 
2.000-4.000 


52 


DENTAL  MEDICINE. 


Remedies. 


Gold  and  sod.  chlor.,  .    . 
Gossyp.,  ex.  fl.,    .    .    . 
Granat.,  ex.  fl.,     .    .    .    . 
Grindeliae,  ex.  fl.,    .    .    . 

Pelletierin.  tan 

Grindel.  ext.  fl.,  .  •  .  . 
Guaiacol,  .    .    .   ■     .    .    . 

carb., 

val.  (seeGeosote).    .    . 
Guaiaci,  tinct.,     .    . 

tinct.  am., 

Guarana, 

Guaranffi,  ex.  fl.,  .    .    .    . 

Guaranin, 

Gurjun,  bals., 

Hamamel,  ex.  fl.,    .    .    . 

Hedeoni.,  ol 

Hellebor.  nig.,  ext.,    .    . 

nig.,  ext.  fi., 

Hematox.  ext.,     .    .    .    . 

Hemogallol, 

Heniol, 

Heroin, 

Hoang-Nan, 

tinct., 

Homatropin.  hydrobrom. 
Humulus,  tinct.,  .  .  .  . 
Lupulin., 

ext.  fl., 

oleores., 

tinct., 

Hydrang.  ex.  fl.,  .  .  . 
Hydrarg.  chlo.  cor.,    .    . 

chlo.  mit., 

c.  creta,     

cyan., 

iodid.  flav., 

iodid.  rub., 

iodid.,  vir., 

massa., 

oxid.  rub., 

subsulph.  flv.,  .    .    .    . 
Hydrast.  ex.  fl.,    .    .    .    . 

tinct.,     . 

Hydrastin., 

(alkaloid) 

Hydrastinine, 

hydrochlor 

Hydrogen,  diox.  aqua,  . 
Hyoscyam.  abs.,  .    .    .    . 

ext.  ale, 

ext.  fl., 

tinct., 

Hyoscin.,  hydrobr.,  .  . 
Hyoscyamin.  sulph.,   .    . 


Dose.     Apoth. 

Dose.     Metric. 

s:;-  ^v-x 

0.0027-0.016 

m  15-45 

1.000-3.000 

3     >^-2 

2.000-8.000 

"     >^-I 

2.000-4.009 

gr-    S-20 

0-333-I-333 

YTL  10-60 

0.666-4.000 

«    2-15  

0.1 33-1.000 

gr.    5-20 

0-333-I-333 

m  5-60 

0.333-4-000 

"  5-30 

0.333-2.000 

gr.  15-60 

1.000-2.000 

"    10-30  

0.666-2.000 

"     1-5 

0.065-0.333 

^  !-6o. ; : ; : 

4.000-8.000 

0.066-4.000 

"  2-5 

0-133-0.333 

gr.  >^-5 

0.033-0.333 

m  5-15  

0.333-1.000 

gr.    5-20 

0.333-1.333 

"      5-20  

0-333-I-333 

"      5-10 

0.333-0.666 

"  tW 

0.005-0.010 

"     3-5 

0.200-0.333 

m  1-5 

0.066-0.333 

gr.    yhi-j\    ■     ■    ■     ■ 

5  i-2>^ 

0.0005-0.001 1 

4.000- 10. ooo- 

gr.    5-10 

0.333-0.666 

m  5-15  

0.333-1000 

gr.     2-5 

0.133-0.333 

^  y2-2 

2.000-8.000 

m3^6o 

2.000-4.000 

'"•^'p^: : : : : 

0.00075-0.006 

o.oi  1-0.533 

"    >^-io  

0.033-0.666 

"t^tV 

0.00067-0.006 

"  i-I 

O.OI  1-0.066 

"    -h~Tt! 

0.0013-0.006 

"  tV>^ 

0.006-0.022. 

"        I-IO  

0.066-0.666 

"  ^\-t\  

0.00 1 3-0.006 

"  X-'A 

0.016-0.033 

m  8-30 

0.533-2.000 

"  30-90  

2.000-6.000 

gr.    S-'o 

0.333-0.666 , 

"   'A-'A 

0.016-0.033 

"  ^^ 

0.005-0.01 1 

"  H-y2 

0.016-0.033 

3     1-4 

4.000-8.000 

gr.     2-5 

0.133^-333 

"      1-2 

0.066-0.133 

m  5-15  

0.333-J-000 

"  15-30  

1.000-2.000 

gr-UWrr    •    ■    •    • 

0.00067-0.001 

"tj-s~s^ 

0.0005-0.002 

POSOLOGICAL   TABLES. 


53 


Remedies. 


Hypnal,  .  .  . 
Hypnon,  .  .  . 
Ichthalbin,  .  . 
Ichthyol,  .  .  . 
Ignatias,  abstr., 

ext.,  .... 

ext.  fl.,  .    .    . 

tinct.,  .  .  . 
Ingluvin,  .  .  . 
lodi,  liq.  com., 

tinct.,  .  .  . 
lodoformum,  . 
lodol,  .... 
Ipecac,  (exp.), 

(emet.),    .    . 

ext.  fl.,  .    .    . 

pulv.,  et  opii, 

syr.,  .... 

tinct.,  et  opii, 

vin.,  .... 
Emetin.  (emet.), 

(expect.). 
Iris,  ext.,  .    .    . 

ext.  fl.,  .  . 
Iridin,  .... 
Jalapa,  .... 

abstr.,    .    .    . 

ext.  fl.,  .    .    . 

pulv.  comp.,  . 

res.,  .... 

tinct.,  .  .  . 
Jambul,     .    .    . 

ex.  fl.,  .  .  . 
Juglans.,  ext.,  . 
Junip.,  ext.  fl., 

oleum,  .     .    . 

spirit,    .    .    . 

spirit,  comp., 
Kairin,  .  .  . 
Kamala,    .    .    . 

ext.  fl.,  .  . 
Kino,     .... 

pulv.  comp., 

tinct.,  .  .  . 
Kolse,  ex.  fl.,  . 
Kramerise,  ext., 

ext.  fl.,  .    .    . 

syr.,  .... 

tinct.,  .  .  . 
Kryofin,  .  .  . 
Lactopeptin,  . 
Lactophenin,  . 
Lactucarium,    . 

ext.  fl.,  .    .    . 

syr.,  .... 


Dose.    Apoth. 

Dose.     Metric. 

gr.  >^-l 

0.033-0.066 

m  5-IO 

0.333-0-666 

gr-    5-IO 

0-333-0-666 

"      3-4 

0.200-0.266 

"  yi-i 

0.033-0.066 

"  Va-'A 

0.016-0.033 

m  1-6 

0.066-0.400 

"       2-IO  

0.133-0.666 

gr.  I0-20 

0.666-1.333 

TTL   i-io 

0.066-0.666 

"     1-5 

0.066-0.333 

gr-     1-3 

0.066-0. 200 

"    >^-2 

0.033-0.133 

"     i-i 

0.0 1 1-0.066 

"    15-30  

1 .000-2.000 

m  1-5 

0.066-0.333 

gr-     2-15 

0.1 33- 1. 000 

3^-2 

m  5-15  

2.000-8.000 

0.333-1.000 

"  1-60  

0.066-4.000 

gr-  %-% 

0.008-0.016 

"   tIWs    •    •    •    • 

0.0005-0.0015 

"    i-s 

0.066-0.333 

ITl  5-30 

0.333-2.000 

gr.     1-3 

0.066-0.200 

"    10-20  

0.666-1.333 

"    i-s 

0.066-0.333 

ttl  15-30 

1.000-2.000 

gr.  10-60 

0.666-4.000 

"      2-5 

0-133-0-333 

Z    %-2 

2.000-8.000 

gr-    5-15 

0.333-1.000 

m  5-20 

0-333-I-333 

gr-    5-20 

0-333-1-333 

TTl  30-60 

2.000-4.000 

"     5-20  

0-333-I-333 

3     1-3 

4.000-12.000 

"     4-8 

16.000-32.000 

gr-     3-30 

0.200-2.000 

^y^lo'.  :     : 

4.000-8.000 

2.000-4.000 

gr-    5-30 

0.333-2.000 

"      5-15  

0.333-1.000 

3  >^-2 

Ill  10-30  

2.000-8.000 
0.666-2.000 

gr-   5-10 

0-333-0-666 

m  5-30 

0.333-2.000 

.1^-4 

m  5-60 

2.000-16.000 

0.333-4-000 

gr-    5-8 

0-333-0-533 

"     5-15  

0-333-1-000 

"     5-'5  

C-333-I-000 

"     5-'5  

0-333-1000 

m  8-30 

0-533-2-000 

3  1-3 

4.000-12.000 

n 


54 


DENTAL  MEDICINE. 


Remedies. 


Lauroceros.  aq.,  .  .  .  . 
Lavandulae,  ol.,    .    .    .    . 

spirit, 

spirit,  comp.,    .    .    .    . 

tinct.,  comp.,  .  .  .  . 
Leptandrae,  ex.,  .  .  .  . 
Leptandrse,  ext.  fl.,  .  . 
Limon.  oleum,  .  .  .  . 
Lith.  benzoas.,     .    .    .    . 

bitart., 

bromid 

carb., 

citras., 

salicylas., 

Lobeliae,  acet.,     .    .    .    . 

ext.  fl.,      

infus., 

tinct., 

Lobelin, 

Lugol's  sol.  (see  lodi).  . 
Lupulin  (see  Humulus). 

Lycetol, 

Lysidin, 

Magnesia, 

Magnes.,  borocitras.,  .    . 

carb., 

citras.  gran.,     .    .    .    . 

glycerophos.,    .    .    .    . 

mist,  et  asaf.,    .    .    .    . 

silic.  hydrat.,    .    .    .    . 

sulphas, 

sulphis, 

Malakin, 

Malarin, 

Malti,  ext., 

Mangan.  binox.,  .    .    .    . 

iodid.  syr., 

sulph., 

Manna, 

Marrub.,  ex.  fl.,  .  .  .  . 
Matico,  ext.  fl.,    .    .    .    . 

tinct., 

Matricar.,  ex.  fl.,  .  .  . 
Menth.  pip.,  ol.,  .    .    .    . 

pip.,  spirit, 

Menthol, 

Methylal,      

Methylene  blue,  .  .  .  . 
Methyl,  salicyl.,  .    .    .    . 

Migrainin 

Moschus, 

tinct., 

Muscarin, 

Mussanin.  pulv.,  .  .  .  . 
Myrrh,  tinct., 


Dose.    Apoth. 

Dose.     Metric. 

m  5-30 

0.333-2.000 

"     1-5 

0.066-0.333 

3/2-^ 

m  30-60 

2.000-4.000 

2.000-4.000 

5  'A-2 

2.000-8.000 

gr.     1-3 

0.066-0.200 

in  20-60  

1.333-4.000 

"    1-5 

0.066-0.333 

gr.    5-15 

0.333-1.000 

"     3-5 

0.200-0.333 

"      5-20  

0333-1333 

"     2-10  

0.133-0.666 

"     2-5 

0133-0.333 

"     5-30 

0.333-2.000 

m  5-30 

0.333-2.000 

"  1-5 

0.066-0.333 

^  5-30;  '.'.'.'. 

4.000-16.000 

0.333-2.000 

gr-'A-^ 

0.033-0.066 

"    15-30  

1.000-2.000 

"      1-5 

0.066-0.333 

«'    15-60 

1.000-4.000 

3    2-4 

8.000-16.000 

gr,  10-60 

0.666-4.000 

!5       2-8 

8.OCO-3  2.000 

gr-    2-5 

0133-0.333 

3  ;^-4 

2.000-16.000 

"   1-2 

4.000-8.000 

«•   1-8 

4.000-32.000 

gr-    5-30 

0.333-2.000 

"      5-10 

0333-0.666 

"      5-15 

0.333-1.000 

3  ^-^A 

4.000-10.000 

gr-    2-5 

0133-0333 

m  10-30  

0.666-2.000 

gr-    2-5 

0133-0333 

I      1-2 

32.000-64.000 

m  30-60 

4.000-8.000 

2.000-4.000 

-^  8-30: : : : ; 

2.000-8.000 

0.533-2.000 

"  1-5 

0.066-0.333 

"  1-30 

0.066-2.000 

gr-    3-5 

0.200-0.333 

m  2-5 

0133-0.333 

gr.     1-2 

0.066-0.133 

m  5-20 

0333-1-333 

gr-     2-5 

0133^-333 

"      2-10  

0.133-0.666 

m  15-60 

I.OOO-4.OOO 

gr.  7V-I 

0.002-0.066 

1       1-2 

32.000-64.000 

lit  10-30 

0.666-2.C00 

POSOLOGICAL   TABLES. 


55 


Remedies. 


Dose.     Apoth. 


m 


Napellin, gr.  ^-^ 

Naphthalin,      

Narcein  (see  Opium).     .    .    . 

Naregani.  tinct., 

Neurodin 

Nicotin, 

Nitroglycerin, 

tabellae  (aa  gr.  x^s).  •    •    • 

tinct., 

Nosophen, 

Nuclein, 

Nux  vom., 

abstr., 

Nux  vom.,  ext., 

ext.  fl., 

tinct., 

Brucin,      

Strychnin  and  salts,     .... 
Opium, 

acet., 

ext., 

liq.  comp., 

Pil.. 

pulv., 

tinct., 

tinct.  camph., 

tinct.  comp., 

tinct.  deed., 

vin., 

Morph.  and  salts, 

pulv.  comp., 

Codein, 

Narcein, 

Orexin 

Orphol, 

Orthoform 

Oxycamphor, 

Pancreatic,  liq., 

Papain, 

Para  form  aldehyd, 

Paraldehyd, 

Pareirae,  ex.  fl., 

Pellotin, 

Pepo,  res., 

Pepsin,  liq., 

pur., 

sacch., 

Peronin, 

Petrolatum, 

Phenacetin, 

Phenocoll, 

Phosphorus, 

pil., 

syr.  comp., 

tinct.  Thompson's,  .... 


1TI 15-30 

gr-  )4-3    ■ 

<i      1        I 
No.  1-2 

gr.  5-8  • 
"    20-60  . 

"     1-5    ■ 

"  H-'A  ■ 

m  1-5  • 
"  5-20  . 

gr.  jy/s  . 

m  5-15 '. 

gr.  X-i     . 

m  5-15  • 

No.  1-2     . 

^-3    . 
5-20  . 

"  5-75  • 

"  1-60  . 

"  5-20  . 

"  5-20  . 

gr.  i^yi . 
"  5-15  ■ 
"  A-l  . 
"  i-H- 

•'  2-5  • 
"    10-15  • 

"      5-15  • 
10-15  • 

1-4    . 

2-10  . 

"    10-20  . 

m  30-60 . 

"  30-60  . 

A-i  . 
10-15  . 

2-4  . 
15-30  . 
5-60 . 

1-2   . 

5-'5  . 
"     5-10 . 

<«   1  _  1 

No.  1-4  . 
"     I 


3 
gr- 


gr- 
gr- 


3 

gr- 


Dose.     Metric. 


0.033-0.018 
0.133-0.666 

1.000-2.000 
0.033-0.200 
0.003-0.006 
0.000335-0.0013 

0.333-0.666 
0.333-0533 

I-333-4-000 
0.066-0.333 
0.016-0.033 
0.008-0.033 
0.066-0.333 

0-333-1.333 
0.006-0.022 
0.001-0.003 
0.0 1 1-0.066 
0-333- 1 -ooo 
0.016-0.066 

0.333-1.000 

0.033-0.200 

0.333- 1 -333 
0.333-5000 
0.066-4.000 

0.333-1.333 

0.003-0.033 

0.333-1.000 

0.033-0.066 
0.0 1 1-0.033 

0-133-0-333 

0.666-1.000 

0.333-1.000 

0.666-1.000 

4.000-16.000 

0.133-0.666 

0.666-1.333 

2.000-4.000 

2.000-4.000 

0.033-0.066 

0.666-1.000 

8.000-16.000 

1.000-2.000 

0.333-4.000 

0.022-0.066 
4.000-8.000 

0.333-1.000 

0.333-0.666 
0.0005-0.0013 

4.000-8.000 
4.000 


5G 


DENTAL  MEDICINE. 


Remedies. 


Phosphorus,  tinct.  (Bellv.  Hosp.), 

oleum, 

Hypophos.  syr., 

c.  fer.,  syr 

Physostig.  ext., 

ext.  fl., 

tinct., .    . 

Physostigmin.  salic, 

sulph., .    . 

eserin, 

Phytolac,  ex.  fl 

tinct., 

Pichl,  ext., 

ex.  fl., 

Picrotoxin  (see  Cocculi).    .    .    . 

Pilocarpi,  ex.  fl., 

Pilocarpin  hydrochl., 

Piper.,  ext.  fl., 

oleores., 

Piperidin  guaiacolat.,      .    .    .    . 

Piperazin, 

Piperin, 

Piscidise,  ex.  fl., 

Picis  liq.,  syr., 

liq.,  vinum,  ....... 

Pix  liq., 

Plumb,  acetas, 

iodid., 

Podophyll.  abs., 

ext., 

ext.  fl., 

res., 

Polygon.,  ext., 

ext.  fl.,       

Potass,  acetas,      

arsen.,  liq., 

bicarb., 

bichromat., 

bitart., 

brom., 

carb., 

chloras., 

citras,    .    .        

citras,  liq., 

citras,  mist., 

cyanid 

ferrocyanid., 

hypophosph., 

iodid., 

liquor, 

nitras, 

permang., 

sulphas,  

sulphid,     

sulphis, 


Dose.    Apoth. 


m  1-3  ■ 

3     I 

"        1-2      . 

m  1-3  . 
"  5-15  • 

or       1-1 
«        1 1 

«     1 1 

Tfl  5-30- 
"   8-60. 

gr.  5-10  . 
3  >^-2    • 

m  s-60. 
m  15-45 

gr-  X-i 
«     6-20  . 

"    5-10  • 

«      1-8    . 

m 15-60  . 
3  2-4  . 

gr-    1-3    • 

"  'A-s  ■ 
"  %-A  ■ 
"  X-i   • 

m  5-30. 

gr.  A- A  ■ 
"    1-5 

trt  10-60 . 

gr.    5-60  . 

TTl  2-10. 

gr.    5-30. 

"  t\-A  . 

3     »-2 
gr.    5-60  . 

"     2-20  . 

"     2-20  . 

"    15-60  . 

f2-4      . 
A-^  ■ 

gr-iV-y  • 
"  5-10  . 
"  5-10  . 
"      2-15  . 

m  5-30. 

gr.  5->S  • 
"  A-^   ■ 

3      1-4    . 

gr.  I- 10  . 
"      3-10  . 


Dose.     Metric. 


2.000 

0.066-0.200 
4.000 

4.000-8.000 
0.004-0.0 1  I 
0.066-0.200 
0.333-1.000 
0.0005-0.001 
0.0005-0.001 
0.001-0.003 
0.333-2000 
0.533-4.000 

0-333-0-666 
2.000-8.000 

0.333-4.000 
0.001-0.033 
1.000-3.000 
0.016-0.066 
0.400-1.333 
0-333-0-666 
0.066-0.533 
1.000-4.000 
8.000-16.000 

32.000-128.000 
0.066-0.200 
0.033-0.200 
0.016-0.033 
0.016-0.066 
0.033-0. 100 
0.333-2.000 
0.008-0.033 
0.066-0.333 
0.666-4.000 
0.333-4000 
0.133-0.666 
0.333-2.000 
0.005-0.022 
4.000-8.000 
0.333-4000 
O.I33-I-333 
o- 133-1-333 
1.000-4.000 
8.000-16.000 

16.000-32.000 
0.004-0.008 
0-333-0-666 
0.333-0-666 
0.1 33- 1. 000 
0.333-2.000 
0.333-1.000 
0.033-0.133 
4.000- 16.000 
0.066-0.666 
0.200-0.666 


POSOLOGICAL  TABLES. 


57 


Remedies. 


Potass,  tartra-boras, 

tartras 

et  sod.  lartr.,     .    .    , 
Prun.  virg.,  ext.  fl,, 

virg.  syr.,      .    .    .    . 
Pulsatil.,  ex.  fl.,    .    .    . 

Pyramidon, 

Pyrantin, 

Quassiae,  ext.,  .    .    .    . 

ext.  fl., 

tinct 

Quebracho,  ex.,    .    . 

ext.  fl 

tinct., 

vin., 

Quebrachin,      .  '.    . 

Resorcin, 

Rheum, 

ext., 

ext.  fl., 

mist.,  et  sod.,    .    . 

pil-, 

pil.  comp.,    . 

pulv.  comp.,      .    . 

syr., 

syr.,  arom.,   .    .    . 

tinct 

tinct.  arom.,      .    . 

tinct.  dulc,   .    .    . 

vin., 

Rhois  aromat.,  ex.  fl., 

glab.,  ex.  fl.,     .    . 

tox.,  ext.  fl.,  .    .    . 

tox.,  tinct.,  .  .  . 
Ricin,  oleum,  .  .  . 
Rosoe,  ext.  fl.,   .    .    . 

syr., 

Rubidii  iodid.,      .    . 

Rubi,  ext.  fl 

Rumic,  ex.  fl.,  .  . 
RutK,  ext.  fl.,   .    .    . 

oleum, 

Sabinae,  ext.  fl.,    .    . 

oleum,   .... 

Salacetol, 

Salicinum,  .... 
Saligenin,  .... 
Salipyrin,      .... 

Salol, 

Salophen,  .... 
Sanguin.,  acet.,    .    . 

ext.  fl., 

tinct., 

Sanguinarinj  .  .  . 
Santal.,  ex.  fl.,      .    . 


Dose.     Apoth. 


g"--     5-15 
K      1-4 

17130-60 
3      1-4 

m  2-5 

gr.    8-30 

"  1-3 
"      1-5 

1TL  30-60 

"  5-60 
gr.     2-8 

m  5-60 
"  1-4 

"  2-10 
"  2-30 
"      5-15 

m 15-45 

No.  I-3 
"  2-5 
gr.  30-60 

3     1-4 

"      1-4 

"      1-8 

m  30-75 
.3  1-4 

"         1-2 

TTL 10-60 
"  30-60 
•«    1-6 

"  tV-^ 
"  '4-2 

"        1-2 

gr.     1-5 

TTt  10-60 
"  15-60 

"  15-30 

"  1-5 

"  5-15 

"  1-3 

gr.  20-30 

<<  5-30 

"  5-8 

"  5-30 

"  5-iS 
"    10-20 

m  10-30 

"  5-15 
"  5-60 

3     1-2 


Dose.     Metric. 


0.333-1.000 
4.000-16.000 
16.000-32.000 
2.000-4.000 
4.000- 1 6.000 
o- 133-0-333 

0.533-2.000 

0.066-0.200 
0.066-0.333 
2.000-4.000 

0.333-4000 

0.133-0.533 
0.333-4.000 

4.000-16.000 
4.000-16.000 
0.050-0. 100 
0.133-0.666 
0.133-2.000 

0.333-1.000 

1.000-3.000 
8.000-32.000 


2.000-4.000 

4.000-16.000 

4.000-16.000 

4.000-32.000 

2.000-5.000 

4.000-16.000 

4.000-8.000 

0.666-4.000 

2.000-4.000 

0.066-0.400 

0.006-0.066 

4.000-32.000 

2.000-8.000 

4.000-8.000 

0.066-0.333 

0.666-4.000 

1.000-4.000 

1.000-2.000 

0.066-0.333 

0.333-1.000 

0.066-0.200 

1.333-2.000 

0.333-2.000 

0.333-0.533 

0.333-2.000 

0.333-1.000 
0.666-1.333 

0.666-2.000 

0.333-1000 
0.333-4000 

0.005-0.016 
4.000-8.000 


58 


DENTAL  MEDICINE. 


Remedies. 


Santal.,  oleum,     . 
Santonica,     .    .    . 

ext.  fl.,  .  .  .  . 
Santoninum,     .    . 

Sapo,     

Sarsap.,  ex.  fl., 

ext.  fl.  comp.,  . 
Sassafras,  ex.  fl.,  . 

oleum,  .... 
Saw  palmetto,  ex., 

ex.  fl.,  .  .  .  . 
Scammonium,  .    . 

res., 

Scilla, 

acet.,      .... 

ext.  fl.,       ... 

ext.  fl.  comp.,   . 

syr., 

syr.  comp.,    .    . 

tinct.,  .... 
Scopalamin,  .  . 
Scopar.,  ex.  fl.,  . 
Scoparin,  .... 
Spartein.  sulph.,  . 
Scutellar.,  ex.  fl., 
Senegse,  abstr.,    . 

ext.  fl.,  .    .    .    . 

syr., 

Senna,   

confect.,    .    .    . 

ext.  fl 

infus.  comp.,     . 

syr., 

Serpent.,  ex.  fl.,   , 

tinct.,  .... 
Sinapis  vol.,  ol.,  . 
Sod.  acetas,  .    .    . 

arsenias,    .    .    . 

arsenias,  liq.,    . 

benzoas,    .    .    . 

bicarb.,      .    .    . 

bisulph.,    .    .    . 

boras,     .... 

brom.,        .    .    . 

cacodylat.,     .    . 

carb.,     .... 

chloras,     .    .    . 

chloras,  liq., 

chlorid.,    .    .    . 

glycerophos.,    . 

hypophosph.,    . 

hyposulpb.,   .    . 

iodid.,    .... 

liquor,    .... 

nitras,    .... 


Dose.    Apoth. 


m 
g>- 
m 

gr. 

It 

5 


m 

g>"- 

3 

gr. 


m 


m 

gr- 

3 

gr- 

U 

5 

gr. 

m 

gr- 
3 


gr. 

m 

gr. 


m 


gr- 


m 

3 


5-30  ■ 

5-60  . 

15-60. 

»-5    ■ 

5-30. 

^-I  ■ 

V2-2  . 

J-5  ■ 
3-5    • 

^-2     . 

3-10  . 

2- 10  . 

1-3  • 
10-30  . 

1-5 

5-30- 

/z-^     ■ 
10-30  . 

5-30  • 

Yz-^   ■ 
tVx   . 

>^-2  . 
5-10. 

5-'5  • 
1-2  . 
5-60  . 
1-2 

1-4    . 

1-2    . 

1-2    . 

10-30  . 

M-%  ■ 
15-60  . 

^VtV  • 
2-15  • 
5-15  ■ 
5-30. 
3-10 . 

5-30. 

5-30- 
%-%■ 

5-30- 

5-20 . 
10-60  . 
10-60 . 

3-5  ■ 
5-10. 
5-20 . 
5-15  ■ 
5-30  • 


Dose.     Metric. 


0.333-2.000 
0.333-4000 
1.000-4.000 
O.066-O.333 
0.333-2.000 
2.000-4.000 
2.000-4.000 
2.000-8.000 
0.066-0.333 
0.200-0.333 
2.000-8.000 
0.200-0.666 

O.I  33-0.666 

0.066-0. 200 
0.666-2.000 
0.066-0.333 

0-333-2-00O 
2.000-4.000 
0.666-2.000 
0.333-2.000 

0.0003-0.001 
2.000-4.000 
0.033-0.066 
0.004-0.066 
2.000-8.000 
0.333-0.666 
0.333-1.000 
4.000-8.000 
0.333-4.000 
4.000-8.000 
4.000-16.000 

32.000-64.000 
4.000-8.000 
0.666-2.000 
2.000-8.000 
0.008-0.0165 
1.000-4.000 
0.001-0.006 
0.1 33- 1. 000 
0.333-1.000 
0.333-2.000 
0.200-0.666 
0.333-2.000 
0.333-2.000 
0.016-0.033 
0.333-2.000 

0.333-1-333 
0.666-4.000 
0.666-4.000 
0.200-0.333 
0.333-0.666 

0.333-1-333 
0.333-1.000 
0.333-2.000 
2.000-4.000 


POSOLOGICAL   TABLES. 


59 


Remedies. 


Sod.  nitris., 

phosphas., 

salicylas,  .    .        

santoninas, 

sulphas, 

sulphis, 

sulpho-carb., 

Solan,  carolin.,  ex.  fl.,     .... 

Solanin, 

Somatose, 

Somnal, 

Spigeliae,  ext.  fl., 

et  sen.,  ex.  fl., 

infus.  comp., 

Stillingise,  ex.  fl., 

tinct., 

Stramon.,  ext., 

ext.  fl., 

tinct., 

daturin, 

Strontii  bromid.,      

iodid., 

lactat., 

salicylat., 

Stroph.,  tinct.,      

Strophantbin, 

Succin.,  oleum, 

Sulplional, 

Sulphur, 

Sumbul,  ex.  fl., 

tinct., 

Suprarenal,  ex., 

Stypticin      (see     Cotarnin     by- 

drocbl.) 

Taka-diastase, 

Tanacet.,  ol., 

Tannalbin, 

Tannigen, •  . 

Taraxac,  ext.,      

ext.  fl.,       

Terebinth.,  ol., 

Terebene, 

Terepin  hydr., 

Terpinol, 

Tetronal, 

Turpent  Chian, 

Thallin 

Thein  (hypo.),      

Theobromin., 

sodio-salicyl.  (see  Diuretin).    . 

Thiocol, 

Thiol, 

Thymol, 

Thymus,  ex., 

Thyroid,  ex., 


Dose.     Apoth. 


"  2-15 

"  5-30 

"  2-10 

"  5-20 

"  5-20 

"  10-30 

"HX  20-60 

1Tl3c^3  2 
"  15-60 

VX  10-60 
gr-  h'A 

m  1-5 
"  5-20 


"  5-20 
"  10-20 
"  10-15 
m  5-10 

gtt.  5-10 

gr-  5-30 
'«    10-60 

m  15-60 
"  5-30 

gr.    3-8 


"  2-5 
gtt-  '-3 
3  >^-2 

gr-     5-15 
"     ^5-15 

^  5-30 

"  5-20 

gr.  5-10 

"  5-15 

"  15-30 

"  3-5 

"  2-15 

"      5-15 

gr.    3-10 
"    J4-2 
"    20-30 
»      1-3 


Dose.     Metric. 


0.033-0.200 

O.I  33- 1. 000 

O.333-2COO 
0.133-0.666 

0-333-I-333 
0-333-I-333 
0.666-2.000 
I-333-4-000 
0.0 1 1-0.066 

15.000-30.000 
2.000-8.000 
1.000-4.000 
2.000-8.000 

32.000-96.000 
0.666-4.000 
2.000-4.000 
o.oi  1-0.033 
0.066-0.333 

0-333-I-333 

0.0005-0.003 

0.666-1.333 

0-333-I-333 
0.666-1.333 
0.666-1.000 
0-333-0-666 
0.0005-0.001 
0.333-0.666 
0.333-2.000 
0.666-4.000 
1.000-4.000 
0.333-2.000 
0.200-0.533 


O.I  33-0.333 
0.066-0.200 
2.000-8.000 
0.333-1-000 
0.333-1000 
2.000-8.000 
0.333-2.000 

0.333-1-333 
0.333-0.666 
0.333-1.000 
1.000-2.000 
0.200-0.333 
0.1 33- 1. 000 
0.01 1-0.066 
0.333-1.000 

2.000-4.000 
0.200-0.666 
0.033-0.133 
1.333-2.000 
0.066-0.200 


60 


DENTAL  MEDICINE. 


Remedies. 


Tiglii,  oleum, 

Tolysol, 

Trimethylam,  hydrochl., 

Trional, 

Tritic,  ext.  fl.,      .    .    .    . 

Tuberculin, 

Tussoi, 

Uranii  nitrat., 

Urethan, 

Urotropin, 

Ustilag.,  ext.  fl.,  .  .  .  . 
Uvae  urs.,  ex.  fl.,  .    .    .    . 

Arbutinum, 

Valerian.,  abst.,    .    .    .    . 

ext., 

ext.  fl., 

oleum, 

tinct., 

tincl.  amm.,  .  .  .  , 
Verat.  vir.,  ex.  fl.,   .    .    . 

tinct., 

Veratrin, 

Viburn.,  ex.  fl.,  .  .  .  . 
Xanthoxy,  ex.  fl.,     .    .    . 

Xeroform, 

Xylol, 

Yerba  sant.  syr.,  .  .  . 
Zinci  acet., 

bromid., 

iodid., 

oxid., 

phosphid,  

sulphas  (em.),      .    .    , 

valerianas, 

Zingib,,  ext.  fl.,    .    .    .    . 

oleores., 

syr., 

tinct,    


Dose,    Apoth. 

Dose.     Metric. 

rny2-2 

0.033-0.133 

gr-    2-5 

o- 133-0333 

"      1-3 

0.066-0.200 

"    15-20  

1.000-1.333 

3     '-4 

4.000-16.000 

gr-  nhs-h    .... 

0.00026-0.004 

"     5-10  

0.333-0.666 

"  H-A 

0.016-0.033 

"  10-15  

0.666-1.000 

"  15-30  

I.OOa-2.000 

m  15-60 

1.000-4.000 

"  10-60  

0.666-4.000 

gr-    3-5 

0.200-0.333 

"     5-15  

0.333-1.000 

"      5-10  

0-333-0-666 

KTl  10-30 

0.666-2.000 

"    2-5 

0.133-0.333 

3^/2-2 

2.000-8.000 

"  }4-2 

2.000-8.000 

Vfl  i-S 

0.066-0.333 

"    3-IO  

0.200-0.666 

gr-^-iV 

3x2-2 

m 15-30 

0.001-0.006 
2.000-8.000 

I.00O-2.000 

gr-     S-'S 

0.333-1.000 

m  5-15  

0.333-1.000 

3  1-4 

4.000-16.000 

gj-  y2-2 

0.033-0.133 

"  y2-2 

0.033-0.133 

"  y2-2 

0.033-0.133 

"        I-IO 

0.066-0.666 

"    ■5'S~TS 

0.00 1 3-0.003 

"     10-30  

0.666-2.000 

"  y2-3  .  .  ■  ■  ■ 

0.033-0.200 

m  s-30 

0.333-2.000 

gr-  y-1 

0.033-0.066 

m»5-6o 

2.000-8.000 

1.000-4.000 

POISONS.  61 


POISONS. 
SYMPTOMS    AND    ANTIDOTES. 

Cases  of  poisoning  require  the  prompt  administration  of  reme- 
dies, and  hence  a  knowledge  of  the  usual  antidotes  is  requisite, 
in  order  that  they  may  be  employed  with  effect. 

For  the  majority  of  such  cases  the  chief  reliance  must  be  upon 
emetics,  so  that  free  vomiting  may  be  induced  by  such  articles  of 
this  class  which  are  most  speedy  in  their  effect.  Sulphate  of 
zinc  is  preferable  to  many,  and,  if  vomiting  is  present,  it  may  be 
aided  by  diluents  or  a  vegetable  emetic.  When  the  poisonous 
substance  has  remained  for  any  length  of  time  in  the  stomach, 
the  use  of  emetics  will  not  prove  sufficient,  but  resort  must  be 
had  to  the  stomach-tube  and  syringe.  Milk,  lime  water,  soap, 
or  solutions  of  sugar  or  honey  will  protect  the  stomach  and  in- 
testines, while  oil  and  other  fatty  matters  may  prove  injurious. 
Carbonate  of  magnesia  with  tincture  of  opium,  suspended  in 
water,  freely  administered,  will  prove  very  serviceable  after  the 
vomiting  has  ceased,  and  the  patient  is  suffering  from  retching 
and  pain. 

When  the  nature  of  the  poison  is  unknown,  a  general  antidote, 
consisting  of  equal  parts  of  calcined  magnesia,  pulverized  char- 
coal, and  hydrated  peroxide  of  iron,  which  are  to  be  diffused  in 
water,  may  be  freely  administered,  and  will,  in  the  majority  of 
cases,  prove  efficient,  as  one  or  another  of  them  is  an  antidote  to 
most  of  the  mineral  poisons. 

The  albumen  of  eggs  and  tannic  acid  are  also  considered  to  be 
valuable  antidotes.  The  albumen  neutralizes  corrosive  sublimate 
and  like  salts,  and  the  tannic  acid  precipitates  all  of  the  vegetable 
alkaloids  as  tannates. 

ACIDS  {Mineral). 

Symptoms. — Corrosion  of  parts  with  which  the  acid  comes  in 
contact,  with  an  immediate  burning  pain  in  the  mouth,  throat, 
assophagus  and  stomach  ;  vomiting  of  liquid  impregnated  with 
mucus  and  blood.  Death  occurs  from  inflammation  or  from 
asphyxia. 

Antidotes. — Chalk;  magnesia;  solution  of  carbonate  of  soda; 


62  DENTAL  MEDICINE. 


emollient  drinks ;  fixed  oil  and  fatty  matter ;   plaster  off  wall,  in 
emergency. 

ACONITE. 

Symptoms. — Numbness  and  tingling  of  the  mouth  and  throat, 
followed  by  vomiting  and  purging ;  giddiness ;  feeble  pulse ; 
dilated  pupil ;  oppressive  breathing ;  paralysis.  Death  occurs 
from  syncope  or  apnea. 

Antidotes. — Emetics ;  stimulants,  external  and  internal,  such  as 
sulphate  of  zinc,  tannic  acid,  animal  charcoal,  atropine,  bella- 
donna. 

ALKALIES  (See  Potash). 
ANTIMONY  {Tartar  Emetic,  Butter  o/ Antimony). 

Symptoms. — A  burning  pain  in  stomach  and  bowels  ;  vomit- 
ing; purging;  cold  perspiration;  great  thirst;  cramps;  great 
debility,  and  death. 

Antidotes. — Vegetable  acids,  such  as  tannic  acid,  catechu,  nut- 
galls,  white  oak  bark,  kino,  cinchona. 

ARSENIC. 

Symptoms. — Faintness  and  nausea,  with  burning  pain  in  the 
epigastrium;  vomiting;  purging,  or  diarrhoea;  thirst;  constric- 
tion in  the  throat ;  feeble  action  of  the  heart,  with  a  quick  and 
weak  pulse ;  painful  and  hurried  respiration  ;  cold  and  clammy 
skin.  Death  occurs  from  collapse,  and  sometimes  with  convul- 
sions. 

Antidotes. — Freshly  precipitated  hydrated  sesquioxide  of  iron 
(made  by  adding  magnesia  to  any  iron  solution);  animal  char- 
coal; ammonia;  lime  water;  stomach  pump;  artificial  respira- 
tion ;  cold  effusion  emetics  ;  milk  ;  raw  eggs. 

ARGENTI  NITRAS  (Nitrate  of  Silver). 

Symptoms. — Corrosion  of  parts ;  sometimes  nausea  and  vomit- 
ing and  convulsions ;   paralysis. 

Antidotes. — Solution  of  common  salt  in  demulcent  drinks; 
albumen. 

ATROPINE. 

Symptoms. — Insatiable  thirst,  with  dryness  of  mouth  and  throat ; 
nausea;  giddiness;  palpitation  of  heart ;  intensely  dilated  pupil, 
coma  and  death. 


POISONS.  63 

Antidotes. — Emetics;  sulphate  of  copper  (gr.  x)  ;  cold  to  head 
ammonia,  externally  and  internally ;  opium ;  animal  charcoal 
calabar  bean  ;  stimulants ;  subcutaneous  injection  of  morphia 
mustard  flour  in  water;  cold  to  head. 

BELLADONNA. 

Symptoms. — Same  as  those  of  atropine. 
Antidotes. — Same  as  for  atropine. 

CANNABIS  INDICA  (^Indian  Hemp). 

Symptoms. — Temporary  insanity,  as  shown  by  a  singular  gait,  a 
constant  rubbing  of  hands,  and  other  strange  actions,  a  peculiar 
and  cunning  appearance  of  the  eyes,  great  hunger. 

Antidotes. — Hot  brandy  and  water  ;  vegetable  acids,  such  as 
lemon-juice,  vinegar,  etc.;  blisters  to  nape  of  neck;  indulgence 
in  sleep. 

CANTHARIDES. 

Symptoms. — A  burning  pain  in  the  stomach ;  vomiting  and 
purging ;  blood-stained  urine ;  pain  in  loins,  strangury ;  pria- 
pism;  convulsions;  death.  • 

Antidotes. — Emetics;  emollient  or  mucilaginous  drinks;  opiates 
by  mouth  and  rectum  ;   venesection,  if  necessary. 

CARBOLIC    ACID. 

Symptoms. — When  taken  internally,  it  causes  pain  in  the 
stomach ;  a  whitened  and  shriveled  appearance  of  the  mucous 
membrane  of  the  lips,  mouth  and  throat ;  sometimes  vomiting  ; 
contracted  pupils;  stertorous  breathing;  coma,  and  death  within 
a  period  of  from  five  to  ten  minutes  to  eight  or  ten  hours,  accord- 
ing to  the  quantity  of  the  acid  swallowed. 

Antidotes. — Olive  oil;  castor  oil;  lime  water;  saccharate  of 
lime ;  precipitated  carbonate  of  lime  ;  albuminous  and  mucilag- 
inous substances  ;  any  soluble  sulphate,  such  as  magnesia. 

CHLORINE    WATER. 

Symptoms. — Irritation    of   air    passages ;    burning    pain    in   the 
throat  and  stomach  ;   vomiting  of  bloody  mucus. 
Antidotes. — Albumen;  white  of  egg;  milk;  flour. 


64  DENTAL  MEDICINE. 


CHLORAL. 

Symptoms. — Excitement ;  delirium  ;  flushed  face  ;  cramps  in 
limbs;  eyes  closed  ;  profound  unconsciousness ;  stertorous  breath- 
ing ;  increasing  feebleness  ;  lividity  of  countenance  ;  loss  of  pulse  ; 
pallor;  coldness  of  extremities  ;  muscular  relaxation;  death  from 
cardiac  syncope. 

Antidotes. — Nitrate  of  amyl,  when  the  poison  has  been  taken 
in  large  quantity ;  strychnia,  when  the  action  of  the  poison  is 
slow  and  culminative.  According  to  some  authorities,  picrotine, 
jV  gr.,  sufficient  for  30  grs.  of  chloral ;  coffee. 

CHLOROFORM. 

Symptoms. — Drowsiness ;  insensibility ;  stertorous,  rapid  breath- 
ing; weak  pulse  ;  dilatation  of  pupils  ;  relaxation  of  muscles  ;  cold- 
ness of  surface ;  increasing  feebleness  of  pulse ;  heart  ceasing  its 
action. 

Antidotes. — Fresh  air;  artificial  respiration  (inclining  head  down, 
tongue  pulled  forward),  cold  water  dashed  over  face  and  chest ; 
galvanism  to  pneumogastric  and  through  diaphragm  (one  pole 
may  be  applied  to  nape  of  neck  and  the  other  to  the  pit  of  the 
stomach);  brandy  and  ammonia  enemata;  hypodermic  injection 
of  15  TU,  of  tincture  of  digitalis,  and  gV  gr.  of  atropine,  or  hypo- 
dermic injection  of  i  drachm  of  ether;  inhalation  of  nitrate  of 
amyl ;  tracheotomy. 

CONIUM  (Hemlock). 

Symptoms. — Thirst;  dryness  of  throat;  delirium;  convulsions; 
coma  and  death,  resulting  from  paralysis  of  the  respiratory 
muscles. 

Antidotes. — Emetics,  followed  by  demulcent  drinks,  internal 
and  external  stimulants,  as  brandy ;  ammonia  ;  coffee,  if  coma  is 
present ;  tannic  acid  ;  animal  charcoal. 

CORROSIVE    SUBLIMATE. 

Symptoms. — Heat  and  pain  of  a  burning  nature  in  mouth,  and 
throat,  and  stomach  ;  nausea  ;  vomiting  of  bloody  mucus ;  diar- 
rhoea; dysentery;  cramps;  convulsions;  coma  and  death. 


POISONS.  65 

Antidotes. — Albumen;  milk;  white  of  egg  (white  of  i  egg  to 
every  4  grs.  of  corrosive  sublimate  taken) ;  flour;  perchloride  of 
tin  ;  iron  and  zinc  (iron  filings  2  parts  and  zinc  i  part);  emetics; 
stomach-pump. 

CREASOTE  (See  Carbolic  Acid). 
CROTON    OIL. 

Symptoms. — Irritation  of  mucous  membrane ;  burning  pain 
along  course  of  alimentary  tract;  excessive  purging;  inflamma- 
tion of  stomach  and  intestines. 

Antidotes. — Emetic  of  sulphate  of  copper,  10  grs.,  followed  by 
mucilaginous  fluids  containing  opium,  to  allay  the  pain  ;  olive 
oil ;   opium. 

SULPHATE    OF    COPPER. 

Symptoms. — Metallic  taste ;  eructations  ;  violent  emesis  and 
purging;  cramps  in  limbs;  griping  pains;  headache;  giddiness; 
convulsions  ;  coma  and  death,  with  symptoms  of  a  disordered 
condition  of  the  nervous  system. 

Antidotes. — Albumen  or  white  of  egg ;  yellow  prussiate  of 
potash,  or  soap. 

DIGITALIS. 

Symptoms. — Nausea  ;  vomiting  ;  purging  ;  feeble  or  slow  and 
irregular  pulse;  dilated  pupils;  excessive  debility  ;  stupor;  con- 
vulsions ;   coma  and  death. 

Antidotes. — Recumbent  posture  after  the  use  of  such  emetics  as 
sulphate  of  zinc ;  stimulate  internally  and  externally ;  tannic 
acid;  animal  charcoal ;  tincture  of  aconite. 

HYDROCYANIC    ACID. 

Symptoms. — Dilated  pupils;  spasmodic  breathing;  convulsions; 
insensibility;  fixed  eyes  ;  spasmodic  closure  of  jaws  ;  very  feeble 
pulse  and  speedy  death. 

Antidotes. — Fresh  air  and  artificial  respiration,  with  cold  affusion 
upon  head  and  neck ;  freshly  precipitated  oxide  of  iron,  with  an 
alkaline  carbonate,  such  as  carbonate  of  ammonia;  chlorine; 
ammonia  by  inhalation  and  injection  in  vein  of  leg. 


QQ  DENTAL  MEDICINE. 


HYOSCYAMUS. 

Symptoms. — A  feeling  of  giddiness,  followed  by  delirium  ;  dilated 
pupils  ;  fullness  about  the  head  ;  drowsiness  ;  cold  perspiration  ; 
paralysis  ;  exhaustion  ;  death. 

Antidotes. — Stomach  pump  ;  emetics  ;  stimulants,  external  and 
internal ;  lemon  juice  ;  strong  coffee. 

IODINE. 

Symptoms. — In  extreme  cases,  violent  vomiting  and  purging ; 
fever  and  excessive  thirst ;  palpitation  of  heart ;  cramps ;  small 
and  frequent  pulse ;  occasional  dry  cough  ;  and  when  death  en- 
sues, it  is  probably  due  to  gastro-enteritis.  In  excessive  doses,  it 
acts  as  an  irritant  poison,  giving  rise  to  such  symptoms  as  rest- 
lessness ;  burning  sensation  ;  palpitation ;  violent  priapism ;  fre- 
quent pulse;  excessive  thirst;  extreme  diarrhoea;  trembling; 
extreme  emaciation,  and  sometimes  syncope. 

Antidotes. — Emetics  and  demulcent  drinks ;  starch  or  flour 
diffused  in  water;  albumen;  milk;  opium  and  external  heat. 

LEAD    SALTS. 

Symptoms. — A  dry  and  constricted  throat;  pain  in  stomach 
and  bowels;  colic;  paralysis  of  extensor  muscles;  apoplectic 
symptoms. 

Antidotes. — Any  soluble  sulphate,  either  magnesia  or  soda ; 
Epsom  salts,  followed  by  emetics,  and  afterwards  opium  and 
milk;  iodide  of  potassium. 

MORPHINE  {See  Opium). 
MERCURY. 

When  in  the  form  of  the  bichloride  (corrosive  sublimate),  or 
nitrate  of  mercury,  see  corrosive  sublimate. 

NUX    VOMICA. 

Symptoms. — Spasmodic  twitching  of  muscles ;  violent  move- 
ment of  limbs  ;  tetanic  spasms  ;  dyspnoea  ;  death. 

Antidotes. — Thirty  grains  of  choral  and  60  grains  of  bromide 
of  potassium.     Nitrate  of  amy  1. 


POISONS.  67 


OPIUM. 

Symptoms. — Increasing  drowsiness  ;  giddiness  ;  stupor  ;  insen- 
sibility :  stertorous  breathing;  feeble  pulse;  contracted  pupil; 
coma;  convulsions;  death. 

Antidotes. — Emetic  of  lo  grs.  of  sulphate  of  copper;  stomach 
pump ;  stimulants,  external  and  internal ;  brandy  and  coffee ; 
artificial  respiration;  cold  affusion;  ammonia  to  nostrils;  en- 
forced exertion  ;  galvanic  shocks ;  belladonna ;  tannic  acid ; 
animal  charcoal ;  atropine  hypodermically. 

OXALIC    ACID. 

Symptoms. — Burning  pain  in  throat,  oesophagus  and  stomach  ; 
vomiting  of  a  dark  green  or  black  fluid,  composed  of  altered 
mucus  and  blood. 

Antidotes. — Chalk  ;  magnesia  ;  plaster  from  wall  in  emergency  ; 
lime,  not  potash  or  soda;  emetics;  stomach-pump. 

PHOSPHORUS. 

Symptoms. — Burning  pain  along  alimentary  tract ;  corrosion  of 
tissues;   vomiting  of  mucus  and  blood;  diarrhoea. 

Antidotes. — Sulphate  of  copper  ;  emetics  and  purgatives. 

POTASH    AND    SODA    SALTS. 

Symptoms. — Sharp,  burning  pain  of  the  mouth,  throat, 
oesophagus  and  stomach  ;  corrosion  ;  vomiting  of  blood  and 
mucus. 

Antidotes. — Dilute  acetic  acid  ;  citric  acid  ;  lemon  juice;  fixed 
oils;  demulcents;  vinegar. 

STRAMONIUM   (See  Belladonna). 
STRYCHNINE. 

Symptoms. — Spasmodic  action  of  muscles  (twitching);  jerking 
of  limbs;  tetanic  spasms  ;  dyspnoea;  death. 

Antidotes. — Chloroform;  belladonna;  tincture  of  aconite; 
morphine  ;  8  grs.  morphine  antidote  to  I  gr.  strychnia ;  extract 
of  conium  ;  also  same  as  nux  vomica. 


68  DENTAL  MEDICINE. 


TOBACCO. 

Symptoms. — Nausea  ;   vomiting  ;   violent  retching. 
Antidotes. — Emetics  ;    stimulants,  both  external   and  internal ; 
strychnia  ;  external  heat. 

ZINC    SALTS. 

Symptoms. — A  burning  sensation  in  stomach  ;  nausea;  vomit- 
ing; anxious  countenance;  difficult  breathing;  small,  quick 
pulse  ;  cold  perspiration  ;  syncope  ;  convulsions  ;  death. 

Antidotes. — Carbonate  of  soda;  emetics;  warm  demulcent 
drinks. 

THE  PULSE. 

The  word  "  pulse  "  is  derived  from  the  Latin  word  pulso.^  "  I 
strike  "  and  denotes  the  striking  or  lifting  of  the  finger  by  the 
distending  vessel,  as  with  each  contraction  of  the  heart  blood 
is  forced  into  the  vessels. 

The  word  pulse  has  also  been  applied  to  the  appearance  of  a 
lifting  up  of  the  coverings  over  a  distending  vessel,  so  that  this 
word  "  pulse  "  is  applied  not  only  to  that  which  is  felt,  but  to 
that  which  is  seen. 

There  are  two  kinds  of  pulse,  the  arterial  and  the  venous. 
The  arterial  is  appreciated  mainly  by  palpitation,  the  venous 
by  inspection.  It  is  the  "  arterial  pulse,"  that  it  is  necessary  to 
study. 

The  "  radial  pulse  "  is  the  one  usually  selected,  although  the 
"  temporal  pulse  "  is  also  noted  in  the  administration  of  anaes- 
thetic agents.  The  pulse  in  other  vessels  must  also  some- 
times be  observed,  as  in  the  brachial,  the  facial  in  front  of  the 
masseter  muscle,  the  posterior  tibial,  the  dorsalis  pedis,  the  carotid 
and  femoral  arteries. 

The  "  radial  pulse,"  the  one  usually  selected,  and  which,  in 
most  cases,  answers  all  the  requirements,  is  of  moderate  size,^ 
superficial,  and  can  be  readily  compressed  against  the  radius. 

When  the  pulse  is  to  be  observed,  the  patient  should  be  either 
sitting  or  lying  down.  The  observer  should  place  his  index, 
middle,  or  ring  finger  lightly  upon  the  pulse,  and  should  then  ap- 


THE  PULSE.  69 


preciate  the  state  of  the  coats  of  the  artery,  and  should  next  note 
the  frequency,  the  rhythm,  the  tension,  volume  and  force  of  the 
pulse ;  and,  lastly,  any  peculiarities,  if  present.  Moreover,  the 
pulse  of  one  side  of  the  body  should  always  be  compared  with 
the  other. 

It  should  also  be  remembered  that  forcible  extension  or  flexion 
of  the  forearm  will  sometimes  arrest  the  radial  pulse. 

In  noting  the  pulse  of  children  and  infants,  it  is  well  to  count 
the  pulse,  if  possible,  while  they  are  asleep. 

This  can  be  conveniently  done  in  the  temporal  artery. 

In  noting  the  pulse  of  the  wrist,  asleep  or  awake,  there  are 
often  involuntary  movements  of  the  arm  and  twitching  of  the 
muscles,  which  render  it  difficult  to  keep  the  finger  of  the  ob- 
server on  the  pulse.  This  difficulty  may  be  overcome  in  a  great 
degree  by  grasping  the  entire  hand  of  the  child,  and  then  extend- 
ing the  index  finger  upon  the  pulse.  It  is  also  advisable  not  to 
take  the  pulse  of  the  patient  until  some  little  time  has  elapsed 
after  the  appearance  of  the  observer.  In  health,  changes  in  the 
frequency  and  rhythm  of  the  pulse  are  often  met  with.  The 
normal  pulse  in  an  adult  is  about  75  beats  per  minute,  while  in 
infants  it  ranges  from  120  to  140  beats  per  minute;  and  the 
very  old  have  a  much  higher  pulse-rate  than  those  of  middle  age. 

The  following  is  a  table  of  the  variations  in  the  frequency  of 
the  pulse  in  health  : — 

Infant  asleep,  at  birth 140 

Infancy 120 

Child  under  5  years  of  age 100 

Youth      90 

Male  adults 72-80 

Female  adults 80-85 

Old  age 70 

It  is  only  in  rare  cases  that  great  frequency  of  the  pulse  in 
health  is  met  with.  Sex  has  some  influence.  Up  to  the  7th 
year  of  age  the  frequency  is  about  the  same  in  both  sexes,  but 
later  the  female  is  from  6  to  14  beats — average  9 — greater  than 
in  the  male. 


70  DENTAL  MEDICINE. 


Posture  also  affects  the  pulse.  It  is  most  frequent  in  the 
standing,  and  least  in  the  recumbent  position. 

The  pulse  of  a  man  is  twice  as  much  affected  by  change  of 
position  as  that  of  a  woman. 

When  the  pulse  is  much  increased  in  frequency,  change  in 
position  has  but  little  effect,  and  for  the  higher  numbers  entirely 
disappears.  When  the  head  is  lower  than  the  body,  the  pulse 
falls.  The  general  law  as  to  the  degree  of  frequency  of  the 
pulse,  as  affected  by  position,  is  as  follows  : — 

The  frequency  is  directly  proportionate  to  the  amount  of 
muscular  effort  required  to  support  the  body  in  different  positions. 
The  pulse  falls  in  sleep,  as  much  as  ten  beats.  Sleeplessness  in- 
creases its  frequency.  On  awakening  from  sleep,  there  is  usually 
a  decided  increase  in  frequency.  Food  increases  the  rate  of  the 
pulse.  Mental  excitement  and  activity  of  the  emotions  increases 
the  frequency  ;  mental  depression  is  often  accompanied  by  a  de- 
crease. Cold  lowers  and  heat  raises  the  rate  of  the  pulse. 
Among  other  causes  producing  an  increase  in  the  frequency  of 
the  pulse  in  health,  are  spirituous  and  warm  drinks,  tobacco, 
diminished  atmospheric  pressure.  Among  other  causes  producing 
diminished  frequency  of  the  pulse,  besides  those  before  mentioned, 
are  fatigue,  long-continued  rest,  debility  without  disease,  and  in- 
creased atmospheric  pressure. 

Occasionally  the  pulse  is  irregular  in  health,  but  when  it  is  so, 
it  is  usually  congenital.  Intermittency  is  not  infrequent  in 
health,  and  it  is  then  either  congenital  or  may  be  due  to  terror, 
anxiety,  grief,  mental  or  physical  fatigue,  and  old  age.  The  in- 
termittency may  be  only  temporary,  or  it  may  become  per- 
manent ;  and  if  it  becomes  very  frequent,  may  be  pathological. 

A  pulse  of  90  or  more  may  be  regarded  as  a  pulse  of  abnormal 
frequency  in  an  adult.  There  are  exceptions  to  this,  but  they 
are  rare.  If  the  pulse  is  quicker  than  the  temperature  will  ex- 
plain, it  indicates  cardiac  weakness. 

A  pulse  that  day  by  day  progressively  increases,  the  tempera- 
ture remaining  the  same,  shows  increased  cardiac  weakness.  In 
all  febrile  diseases,  a  pulse,  in  adults,  over  120  is  serious,  and  in- 
dicates cardiac  weakness.     A  pulse  of  130  or  140  indicates  great 


THERMOMETERS.  71 

danger;  and  with  a  pulse  at  i6o,  the  patient  almost  always 
dies. 

Under  the  age  of  fifteen,  any  disease  of  the  lungs  is  almost 
invariably  accompanied  by  great  frequency  of  the  pulse,  so  that 
a  pulse  of  120  to  140  would  not  be  considered  as  so  serious  in 
significance  as  if  it  occurred  in  an  older  person. 

A  soft,  rapid,  small  pulse  indicates  great  weakness,  and  an 
irregular  or  intermittent  pulse  indicates  functional  or  organic 
disease  of  the  heart. 

A  pulse  of  120  in  a  strong,  robust  patient  affected  with  pneu- 
monia, indicates  some  form  of  heart-disease.  When  pneumonia 
occurs  in  the  cachectic  or  debilitated,  the  pulse  is  usually  very 
frequent,  often  120  to  160,  and  such  cases  usually  die.  In  peri- 
carditis and  myocarditis,  there  is  great  frequency  of  the  pulse, 
especially  on  any  movement  of  the  patient — 130  to  160 — and 
the  change  may  be  very  sudden.  In  acute  articular  rheumatism, 
unaccompanied  by  any  heart  disease,  a  pulse  of  120  or  more  in- 
dicates great  danger.  In  pleuritic  effusions,  the  pulse  may  be 
very  frequent,  especially  when  there  is  displacement  of  the  heart. 

RESPIRATIOX    AT  VARIOUS  STAGES. 

At  one  year  of  age,  per  minute 35 

"  two  years  of  age  "        "         25 

"  puberty                  "        "         20 

"  adult  age,               "        "        .        18 

THERMOMETERS. 

There  are  three  different  thermometers  in  use — Fahrenheit's, 
Centigrade  and  Reaumur's — each  differing  from  the  other  with 
reference  to  the  number  of  degrees  between  the  freezing  and 
boiling  points  of  water.  In  Fahrenheit's,  zero  is  placed  at  32 
degrees  below  the  freezing  point,  while  in  the  others  zero  marks 
the  freezing  point. 

The  boiling  point  in  Fahrenheit's  is  placed  at  202  degrees ;  in 
Centigrade  at  100,  and  in  Reaumur's  at  80. 

The  degrees  between  the  freezing  and  boiling  points  in  the  in- 
struments are,  therefore,  respectively  180,  100  and  80. 


72  DENTAL   MEDICINE. 

The  following  diagram  will  explain  the  variance : — 

Fahrenheit o.             32       77        122       167  212 

Centigrade 1777         °       25         50         75  100 

Reaumur     ........  14.22         o       20         40         60  80 

When  a  thermometer,  in  the  process  of  vulcanizing,  gives 
trouble  by  the  column  of  mercury  becoming  divided,  the  divided 
portion  remaining  in  the  top  of  the  tube,  the  best  method  is  to 
unscrew  the  thermometer  and  turn  it  upside  down,  and  make  the 
mercury  in  the  bulb  unite  with  the  mercury  in  the  tube,  so  that 
it  may  coalesce  perfectly.  This  is  a  better  method  than  striking 
the  thermometer  sharply  in  the  hollow  of  the  left  hand,  and 
thereby  risking  the  breaking  of  the  thin  glass  tube. 

Temperature. —  The  Clinical  Thermometer  is  employed  as  a  valu- 
able means  of  diagnosis  and  prognosis.  It  is  valued  because  the 
vital  processes  can  only  be  normally  and  perfectly  performed  at 
the  temperature  of  98.5°,  and  just  in  proportion  as  it  varies  from 
this,  either  above  or  below,  they  are  changed  or  entirely  arrested. 
This  standard  of  temperature,  98.5°,  of  the  healthy  body,  is  sub- 
ject to  slight  variations  during  the  day.  A  temperature  of  105° 
is  usually  considered  dangerous  and  107°  is  generally  fatal;  any 
rise  above  the  normal  indicates  fever,  and  a  decrease  indicates 
shock  or  collapse.  Although  observations  show  that  the  normal 
heat,  which  is  the  most  essential  condition  of  life,  may  be  con- 
siderably altered  by  a  number  of  circumstances,  yet  the  variations 
in  health  are  generally  temporary  and  within  narrow  limits, 
whereas  those  which  arise  from  disease  are  persistent  during  the 
continuance  of  the  abnormal  condition.  Both  increase  and  de- 
crease of  temperature  have  to  be  considered,  for  while  an  increase 
of  four  to  six  degrees  may  be  maintained  for  a  month,  and  not 
endanger  life,  a  decrease  of  but  one  degree,  if  maintained  for  a 
considerable  time,  will  result  in  death.  The  temperature  in 
fevers  is  highest  in  the  evening  and  lowest  in  the  morning.  But 
in  the  fever  resulting  from  difficult  dentition  the  temperature  is 
highest  in  the  morning  and  lowest  in  the  evening.  The  increase 
in  temperature  of  the  body  is  usually  proportionate  to  the  fre- 
quency of  the  pulse,  one  degree  corresponding  to  an  increase  of 
ten  beats  per  minute.     Thus  — 


THERMOiMETERS. 


73 


With  a  temperature   of  980,  we  have  a  pulsation  of  60. 


99°. 

" 

70 

lOOO, 

« 

80 

lOlO, 

" 

90 

I020, 

" 

"            100 

I030, 

" 

"           no 

I040, 

" 

"            1 20. 

TABLE    OF    ELEMENTARY    SUBSTANCES. 


— ■ 

__■ 

Elements. 

Symbc 

Atomic 
Weight. 

Equiva- 
lent. 

Elements. 

0 

(Al 

Mo 

Atomic 
Weight. 

Equiva- 
lent. 

Aluminum  .    .    . 

Al 

27 

13-5 

Molybdenum     . 

95-5 

42.75 

Antimony   . 

Sb 

120 

120 

Nickel    .... 

Ni 

58 

29 

Arsenic   .    . 

As 

75 

75 

Niobium 

Nb 

94 

94 

Barium   .    . 

Ba 

137 

68.4 

Nitrogen  ^ . 

N 

14.03 

14. 

Berylium 

Be 

9 

9 

Osmium     . 

Os 

198.5 

99-25 

(Glucinum. 

Oxygen  < 

0 

16 

8 

Bismuth 

Bi 

208.5 

208.5 

Palladium 

Pd 

105.7 

52.85 

Boron      .    . 

B 

II 

II 

Phosphorus 

P 

31 

31 

Bromine 

Br 

79-95 

79-95 

Platinum 

Pt 

194.4 

97.2 

Cadmium    . 

Cd 

111.8 

55-9 

Potassium  . 

K 

39-" 

39-" 

Cesium    .    . 

Cs 

132.6 

132.6 

Rhodium 

Rh 

104. 1 

52.05 

Calcium 

Ca 

40 

20 

Rubidium 

Rb 

85-3 

85-3 

Carbon  ^ 

C 

12 

6 

Ruthenium 

Ru 

104.2 

52.1 

Cerium    .    . 

Ce 

140.2 

70-5 

Scandium 

Sc 

44 

22 

Chlorine'    . 

CI 

35-45 

35-45 

Selenium 

Be 

78.8 

39-4 

Chromium  . 

Cr 

52-1 

26.2 

Silicon    . 

Si 

28.4 

14 

Cobalt     .    . 

Co 

58.9 

29-45 

Silver     . 

Ag 

107.92 

107.92 

Copper    .    . 

Cu 

63-4 

31.6 

Sodium  . 

Na 

23-05 

23-05 

Didymium 

Di 

144.6 

72-3 

Strontium 

Sr 

87-4 

43-7 

Erbium    .    . 

E 

165-9 

82.95 

Sulphur* 

S 

■32.06 

16 

Fluorine 

■   Fl 

19 

19 

Tantalum 

Ta 

182 

182 

Gallium  .    . 

G 

68.8 

34-4 

Tellurium 

Te 

128 

64 

Gold     .    .    . 

Au 

197-3 

197-3 

Thallium 

Tl 

203.7 

203.7 

Hydrogen    . 

H 

1.007 

1.007 

Thorium 

\  Th 

233. 

1 16.5 

Indium    .    . 

In 

"3-4 

567 

Tin     :    . 

Sn 

"7-7 

58-85 

Iodine      .    . 

I 

126.85 

126.85 

Titanium 

Ti 

48 

24 

Iridium    .    . 

Ir 

192.7 

96-35 

Tungsten 

Tr 

183.6 

91.8 

Iron     .    .    . 

Fe 

56 

27-95 

Uranium 

U 

238-5 

119.25 

Lanthanum 

I>a 

138-5 

138.5 

Vanadium 

V 

51-3 

51-3 

Lead    .    .    . 

Pb 

206.95 

103.25 

Ytterbium 

Yb 

172.7 

172.7 

Lithium  .    . 

Li 

7.02 

7.02 

Yttrium 

Y 

89.8 

89.8 

Magnesium 

Mg 

24.3 

12 

Zinc    .    .    . 

Zn 

65-3 

32-45 

Manganese 

Mn 

55 

27 

Zirconium  . 

Zr 

90 

45 

Mercury 

Hg 

200 

_?9i85_ 

'Carbon:  11.9736.    "Chlorine:  35.370.     ^Nitrogen:  14.021.    *  Oxygen:  15.9633.    'Sulphur: 
31.984. 


74 


DENTAL  MEDICINE. 


Table  of  the  Solubility  of  Chemicals  in  Water  and  Alcohol. 

Abbreviations  \    "■  =  ^o'^ble  ;   ins.  =  insoluble  :   sp.  =  sparingly. 
<    V.  =  very  ;   aim.  =  almost  ;   dec.  =  decomposed. 


CHEMICALS. 


One  part  is  soluble  in  : 

Acidum  arseniosum 

Acidum  benzoiciim 

Acidum  boricum 

Acidum  carbolicum 

Acidum  chromicum 

Acidum  citricum 

Acidum  gallicum 

Acidum  salicylicum 

Acidum  tannicum 

Acidum  tartaricum 

Alumen 

Alumen  exsiccatum 

Ammonii  carbonas 

Ammonii  nitras 

Ammonii  valerianas 

Antimonii  et  potassii  taitras 

Argenti  cyanidum 

Argenti  iodium 

Argenti  nitras 

Argenti  nitras  fusus 

Argenti  oxidum 

Atropina 

Atropinae  sulphas 

Bismuth  subnitras 

Bromum 

Calcii  bromidum 

Calcii  carbonas  praecipitatus     . 

Calcii  chloridum 

Calcii  hypophosphis 

Calcii  phosphas  prsecipitatus    . 

Calx 

Camphora  monobromata  .    .    . 

Chloral 

Cinchonidinje  sulphas  .... 

Cinchonina     

Cinchoninee  sulphas 

Codeina 

Creta  prseparata 

Cupri  acetas 

Cupri  sulphas 

Ferri  chloridum 

Ferri  citras 

Ferri  lactas 

Ferri  sulphas 

Ferri  valerianas 

Hydrargyri    chloridum   corrosi- 

vum 

Hydrargyri  chloridum  mite 


WATER. 

ALCOHOL. 

At  15°  C. 
(50°  F.) 

Boiling. 

At  15°  C. 

(50°  F.) 

Boiling. 

Parts. 

Parts. 

Parts. 

Parts. 

30.80 

'5 

sp. 

sp. 

500 

15 

3 

I 

25 

3 

'5 

5 

20 

. 

V.  s. 

V.  s. 

V.  s. 

V.  s. 

dec. 

dec. 

0.75 

0-5 

I 

0-5 

IOC 

3 

4-5 

I 

450 

14 

2.2 

V.  s. 

6 

V.  s. 

0.6 

V.  s. 

0.7 

0.5 

2-5 

0.2 

lo.s 

ms. 

03 

ms. 

20 

ins. 

0.7 

ins. 

4 

dec. 

dec. 

dec. 

05 

V   s. 

20 

3 

V.  s. 

V.  s. 

V.  s. 

V.  s. 

17 

3 

ins. 

ms. 

ms. 

ms. 

ins. 

ms. 

ins. 

ins. 

ms. 

ins. 

0.8 

0.1 

26 

5 

0.6 

o-S 

25 

5 

V.  sp. 

V.  sp. 

ins. 

ins. 

600 

35 

V.  s. 

V.  s. 

0.4 

V.  s. 

6-5 

V.  s. 

ins. 

ins. 

ms. 

ms. 

33 

.     . 

dec. 

dec. 

0.7 

V.  s. 

I 

V.  s. 

ms. 

ms. 

ms. 

ins. 

1.5 

V.  s. 

8 

1-5 

6.8 

6 

ms. 

ms. 

ins. 

ms. 

ins. 

ins. 

750 

1300 

ins. 

ms. 

.  aim.  ins. 

aim.  ins. 

V.  s. 

V.  s. 

V.  s. 

V.  s. 

V.  s. 

V.  s. 

100 

4 

7» 

12 

aim.  ins. 

aim.  ins. 

no 

28 

70 

H 

6 

1-5 

80 

17 

V.  s. 

V.  s. 

ins. 

ins. 

ms. 

ins. 

'5^ 

5 

135 

14 

2.6 

0.5 

ins. 

ins. 

V.  s. 

V.  s. 

V.  s. 

V.  s. 

s. 

V.  s. 

ins. 

ins. 

40 

12 

aim.  ins. 

aim.  ins. 

1.8 

0-3 

ins. 

ins. 

ins. 

dec. 

V.  s. 

V.  s. 

16 

2 

2 

1.2 

ins. 

ms. 

ins. 

ms. 

CHEMICALS  SOLUBLE  BY  WATER  AND  ALCOHOL. 


iO 


Table  of  the  Solubility  of  Chemicals  in  Water  and  Alcohol  (Continued). 


CHEMICALS. 


One  part  is  soluble  in  : 
Hydrargyri  cyanidum  .    .    . 
Hydrargyri  iodidum  rubrum 
Hydrargyri  iodidum  viride  . 
Hydrargyri  oxidum  flavum  . 
Hydrargyri  oxidum  rubrum 
Hydrargyrum  ammoniatum 
Hyoscyaminas  sulphas   .    .    . 

Iodoform 

lodum 

Magnesia 

Magnesii  carbonas     .    .    .    . 

Magnesii  sulphas 

Magnesii  sulphis 

Mangani  oxidum  nigrum 

Mangani  sulphas 

Morphina 

Morphinse  acetas 

Mophinas  hydrochloras  .  . 
Morphinae  sulphas     .    .    .    . 

Phorphorus     

Piperina      

Plumbi  acetas 

Plumbi  carbonas 

Plumbi  iodium 

Plumbi  nitras  2 

Plumbi  oxidum      

Potassa 

Potassii  acetas 

Potassii  bicarbonas  .  .  .  . 
Potassii  bichromas     .    .    .    . 

Potassii  bitartras 

Potassii  bromidum     .    .    .    . 

Potassii  carbonas 

Potassii  chloras 

Potassii  citras 

Potassii  cyanidum  .  .  .  . 
Potassii  ferrocyanidum  .  .  . 
Potassii  hypophosphis  .    .    . 

Potassii  iodidum 

Potassii  nitras 

Potassii  permanganas    .    .    . 

Potassii  sulphas 

Potassii  tartras 

Quinidinoe  sulphas     .    .    .    . 

Quinina 

Quininre  bisulphas  .  .  .  . 
Quininse  hydrochloras  .    .    . 

Quinince  sulphas 

Quininje  valerianas  .  .  .  . 
Saccharum 


WATER. 

Alcohol. 

At   15°  C. 

(50°  F. 

Boiling. 

At  15°  C. 

(50°  F.) 

Boiling. 

Parts. 

Parts. 

Parts. 

Parts. 

12.8 

3 

IS 

6 

aim.  ins. 

aim.  ins. 

130 

15 

aim.  ins. 

aim.  ins. 

ins. 

ins. 

ins. 

ins. 

ins. 

ins. 

ins. 

ins. 

ins. 

ins. 

ins. 

ins. 

ins. 

ins. 

V.  s. 

V.  s. 

V.  s. 

V,  s. 

ins. 

ins. 

80 

15 

sp. 

II 

aim.  ins. 

aim.  ins. 

ins. 

ms. 

aim.  ins. 

aim.  ins. 

ins. 

ins. 

0.8 

0.15 

ins. 

ins. 

20 

19 

ins. 

ins. 

ins. 

ins. 

ins. 

ins. 

0.7 

0.8 

ins. 

ins. 

V.  sp. 

500 

100 

36 

12 

1-5 

68 

14 

24 

0-5 

63 

31 

24 

0-7S 

702 

144 

ins. 

ins. 

V.  sp. 

V.  sp. 

aim.  ins. 

aim.  ins. 

30 

I 

1.8 

0-5 

8 

I 

ins. 

ins. 

ins. 

ins. 

2000 
2 

200 

0.8 

V.  sp. 
aim.  ins. 

V.  sp. 
aim.  ins. 

ins. 

ins. 

ins. 

ins. 

0.5 

V.  s. 

2 

V.  s. 

0.4 

V.  s. 

2-5 

V.  s. 

3-2 

dec. 

aim.  ins. 

aim.  ins.  * 

10 

1-5 

ins. 

ins. 

2ia 
1.6 

15 
I 

V.  sp. 
200 

V.  sp. 
16 

I 

0.7 

ins. 

ins. 

16.5 

2 

V.  sp. 

V.  sp. 

0.6 

V.  s. 

V.  sp. 

V.  sp. 

2 

I 

sp- 

sp. 

4 

2 

ins. 

ins. 

0.6 
0.8 

0-3 

0.5 

7-3 
18 

3-6 
6 

4 

0.4 

aim.  ins. 

aim.  ins. 

20 

3 

dec. 

dec. 

9 

4 

ins. 

ins. 

0.7 

0-5 

aim.  ins. 

aim.  ins. 

100 

7 

8 

V.  s. 

1600 

700 

6 

2 

10 

V.  s. 

32 

V.  s. 

34 
740 

I 
30 

3 
65 

V.  s. 
3 

100 

40 

5 

I 

0-5 

0.2 

175 

28 

76 


DENTAL  MEDICINE. 


Table  of  the  Solubility  of  Chemicals  in  Water  and  Alcohol  (Continued), 


CHEMICALS. 


One  part  is  soluble  in  ; 
Saccharum  lactis    .    .    . 

Salicinum 

Soda 

Sodii  acetas 

Sodii  bicarbonas    .    .    . 

Sodii  boras 

Sodii  carbonas   .... 

Sodii  chloras 

Sodii  chloiidum  .  .  . 
Sodii  hypophosphis  .  . 
Sodii  hyposulphis  .  .  . 
Sodii  iodidum    .... 

Sodii  nitras 

Sodii  sulphas 

Sodii  sulphis 

Strychnina      

Strychninae  sulphas  .  . 
Sulphur  lotum  .... 
Sulphur  prsecipitatum  . 
Sulphur  sublimatum 

Thymol 

Veratrina    ...... 

Zinc 
Zinc 
Zinc 
Zinc 
Zinc 
Zinc 
Zinc 
Zinz 


acetas 

carbonas  prsecipitatus 

chloridum 

iodidum 

oxidum , 

phosphidum      .    .    .    . 

sulphas 

valerianas 


At  15°  C. 
(50°  F.) 


Parts. 

7 
28 

1-7 
3 

12 

16 
1.6 
I.I 
2.8 
I 

1-5 
0.6 

1-3 

2.8 

4 
6700 

10 

ins. 

ins. 

ins. 
1200 
V.  sp, 

3 
ins. 
V.  s. 
V.  s. 
ins. 
ins. 

0.6 
100 


Boiling. 


Parts. 
I 

0.7 
0.8 
I 
dec. 

O-S 
0.25 

O-S 
2-5 
0.12 

OS 
03 
0.6 
0.4 
0.9 
25000 
2 
ins. 
ins. 
ins. 
900 
V.  sp. 

.  ^-5 
ins. 

V.  s. 

V.  s. 

ins. 

ins. 
03 


ALCOHOL. 


At  15°  C. 
(50°  F.) 


Parts. 

ins. 

30 
V.  s. 

30 

ins. 
ins. 
ins. 
40 
aim.  ins. 

30 
ins. 

1.8 
sp. 
ins. 
sp. 
no 
60 
ins. 
ins. 
ins. 

I 

3 
30 
ins. 
V.  s. 
V.  s. 
ins. 
ins. 
ins. 
40 


Boiling. 


Parts, 
ins. 
2 
V.  s. 
2 
ins. 
ins. 
ins. 

43 

aim.  ins. 

I 

ins. 

1-4 

40 

ins. 

sp. 

12 

2 

ins, 

ins. 

ins. 

V.  s. 

V.  s. 

.  3 

ins. 
V.  s. 
V.  s. 

ins. 

ins. 

ins. 


NATURAL  DISTRIBUTION  OF  REMEDIES. 


T7 


Ammonium. 

Barium. 

Calcium, 


NATURAL  DISTRIBUTION  OF  REMEDIES. 
INORGANIC    MATERIA    MEDICA. 

ALKALIES    AND   ALKALINE   EARTHS. 

Cerium. 
Lithium. 
Manganese. 


Potassium. 
Sodium. 


Aluminum. 

Antimony. 

Arsenic. 

Bismuth. 

Copper. 


Bromine.  1 
Chlorine.  ! 
Fluorine,  j 
Iodine.      j 


Acetic. 
Benzoic. 
Carbolic. 
Citric. 


Boric. 
Chromic. 
Hydrochloric. 
Hydrobromic. 


Acetanilid. 

Acetic  ether. 

Alcohol. 

Amyl  Nitrate. 

Antipyrin. 

Carbolic  Acid, 

Chinolin. 

Chloral  hydrate. 

Chloroform. 

Croton  Chloral. 

Ether. 

Ethyl  bromide. 


Halogens. 


METALS. 

Gold. 

Nickel. 

Iron. 

Phosphorus. 

Lead. 

Silver. 

Manganese. 

Zinc, 

Mercury, 

NON-METALS, 

Charcoal. 

Peroxide  of  hydrogen. 

Oxygen. 

Sulphur. 

Ozone. 


ACIDS. 

Organic. 

Gallic  (pyrogallic). 

Oleic. 

Hydrocyanic. 

Salicylic. 

Lactic. 

Tannic. 

Meconic, 

Tartaric. 

Inorganic. 

Nitric  (oxalic). 

Phosphoric. 

Nitrohydrochloric, 

Sulphuric. 

Nitrous. 

Sulphurous. 

CARBON   COMPOUNDS. 

Ethyl  iodide. 

Nitrous  ether. 

Ethylate  of  sodium. 

Nitrous  oxide. 

Ethidene  bichloride. 

Paraldehyde, 

Fuchsin. 

Petrolatum, 

Hydrocyanic  acid. 

Phenacetin, 

Iodoform. 

Pyrodin. 

lodol. 

Resorcin. 

Kairin. 

Salol. 

Methylene  bichloride. 

Thallin. 

Naphthol,  Naphthalin. 

Trymethylamine. 

Nitroglycerin. 

Ural  (Uralium), 

Urethran, 

n 


DENTAL  MEDICINE. 


ORGANIC    MATERIA    MEDICA. 

Composed  of  the  Vegetable  Kingdom,  which  includes  plants  used  for  medic- 
inal purposes,  and  the  Animal  Kingdom,  as  follows : 
Cantharides.                             Ichthyol.  Pancreatin. 
Castor.                                      Isinglass.  Pepsin. 
Cochineal.                                Lanolin.  Soap. 
Cod  Liver  Oil.                       Lard.  Spermaceti. 
Albumen  and  Yolk  of  Egg.  The  Leech.  Suet. 
Formic  acid.                            Milk.  Sugar  of  Milk. 
Honey  and  Wax.                    Musk. 

CLASSIFICATION  OF  MEDICINAL  SUBSTANCES. 
In  order  to  impress  the  memory  and  facilitate  investigation,  it 
is    necessary  that  medicinal  substances  should  be  classified  ac- 
cording to  their  similarity  of  action  on  the  animal  economy,  as 
follows : 


I.  Neurotics,  or  those  which  have  a  special 
action  on  and  modify  the  functions  of  the 
nervous  system.     To  this  group  belong  : 


2.  EccRiTics,  or  those  which  have  a  special 
action  on  the  secretions.  To  this  group 
belong : 

3.  Hemetics,  or  those  which  modify  the  blood. 
To  this  group  belong  : 

4.  Topical  Remedies.     To  this  group  belong : 


Hypnotics  and 

Narcotics, 

Anaesthetics, 

Antispasmodics, 

Tonics, 

Astringents, 

Stimulants, 

Sedatives, 

Spinants. 

Emetics, 

Cathanics, 

Diaphoretics, 

Diuretics, 

Blennorrhetics, 

Emmenagogues. 

Hematinics, 

Alteratives, 

Antacids. 

Irritants, 

Demulcents, 

Antiseptics, 

Disinfectants, 

Coloring  Agents, 

Anthelmintics. 


DEFINITIONS  OF  THE  VARIOUS  CLASSES  OF  REMEDIAL 
AGENTS. 

HYPNOTICS    AND    NARCOTICS. 

Hypnotics  and  narcotics  are  medicinal  substances  which  affect 
the  cerebral  and  spinal  functions  by  impairing  or  destroying  nerv- 
ous action,  having  first  a  stimulant  effect,  to  which  their 
therapeutic  efficacy  is  in  a  great  degree  due.     They  allay  cerebral 


REMEDIAL   AGENTS.  79 


or  spinal  irritability,  relieve  muscular  spasm  and  also  pain,  and 
induce  sleep.  When  administered  to  relieve  pain,  they  are 
termed  anodynes ;  to  induce  sleep,  they  are  termed  hypnotics  or 
soporifics. 

Narcotics  fulfill  two  indications,  namely  :  Exciting  and  de- 
pressing the  nervous  energy.  For  the  first  it  is  necessary  to 
begin  with  small  doses  and  repeat  them  frequently ;  for  the 
second,  a  full  dose  must  be  given  and  not  repeated  for  a  consider- 
able time.  On  account  of  the  system  becoming  very  soon 
habituated  to  the  action  of  narcotics,  when  it  is  necessary  to  re- 
sort to  their  use  for  any  length  of  time  the  amount  must  be  con- 
stantly increased,  in  order  to  maintain  the  same  impression.  The 
difference  between  the  susceptibility  to  their  action  when  the 
body  is  in  a  morbid  or  healthy  condition  should  not  be  over- 
looked. Hypnotics  diminish  the  cerebral  circulation  by  modify- 
ing vascular  activity. 

Under  narcotics  and  hypnotics  are  classed  such  agents  as 
opium  and  its  different  preparations,  chloral,  lactucarium,  bella- 
donna, stramonium,  hyoscyamus,  tobacco,  lobelia,  conium, 
aconite,  cannabis  indica,  humulus,  camphor,  hydrocyanic  acid, 
aconite,  alcohol,  chloroform,  digitalis,  ether,  paraldehyde,  potas- 
sium bromide,  sulphonal,  urethran,  zinc  bromide,  etc.,  etc. 

ANESTHETICS. 

Anaesthetics  are  medicinal  agents  which  diminish  sensibility 
and  relieve  pain.  They  are  generally  in  the  form  of  vapors  or 
gases,  applied  by  inhalation,  and  possess  the  power  of  tempo- 
rarily suspending  the  general  sensibility,  being  commonly  em- 
ployed for  the  prevention  of  pain  during  surgical  operations. 
They  are  divided  into  general  and  local  anaesthetics. 

General  anaesthetics  are  agents  capable  of  producing  complete 
insensibility  throughout  the  whole  system.  Included  in  this  class 
are  such  agents  as  ether,  chloroform,  nitrous  oxide  gas,  bromide 
of  ethyl,  bichloride  of  methylene,  tetrachloride  of  carbon, 
bichloride  of  ethidene,  bromoform,  iodide  of  ethyl,  tetrachloride 
of  carbon,  trichlorhydrin,  etc.,  etc. 

Local  anaesthetics   are  agents  whose  action  is  limited  to  a  cer- 


/ 

80  DENTAL  MEDICINE. 


tain  part  or  organ,  when  topically  applied,  paralyzing  the  nerves 
of  the  part,  and  temporarily  destroying  the  sensibility.  In- 
cluded in  this  class  are  such  agents  as  absolute  ether,  rhigolene, 
aconite,  pyrethrum,  atropine,  cocaine,  etc.,  etc. 

ANTISPASMODICS. 

Antispasmodics  are  medicinal  agents  which  allay  irregular 
muscular  contraction  or  spasm,  and  compose  the  irregular  actions 
of  the  nervous  system,  without  any  special  or  decided  effect  on 
the  brain.  They  are  employed  in  many  varieties  of  mental  dis- 
turbance, insanity,  wakefulness,  hypochondriasis,  convulsions 
from  teething,  spasms  from  general  debility,  in  which  latter  case 
an  aromatic  stimulant  of  the  circulation  and  a  permanent  tonic 
prove  beneficial.  In  hysteria,  dependent  upon  idiopathic  or 
primary  nervous  irritation,  the  use  of  antispasmodics  is  indicated. 
Included  in  this  class  *are  such  agents  as  asafetida,  musk,  camphor, 
valerian,  galbanum,  ammoniac,  castor,  compound  spirit  of  ether 
(Hoffman's  anodyne),  etc. 

TONICS. 

Tonics  are  medicinal  agents  which  impart  strength  to  the 
system,  producing  a  gradual  and  permanent  increase  of  nervous 
vigor,  without  preternatural  excitement.  They  stimulate  also  in 
a  secondary  manner,  by  gradually  increasing  the  force  of  the  cir- 
culation, and  restoring  the  digestive  and  secretory  functions  to  a 
more  healthy  state,  differing,  however,  from  stimulants,  in  the 
more  permanent  character  of  their  effects. 

Certain  agents  of  this  class,  when  administered  in  large  doses, 
act  as  antiperiodics  in  intermittent  diseases.  Benefit  also  results 
in  the  use  of  tonics  by  alternating  them.  They  are  divided  into 
vegetable  and  mineral  tonics,  the  former  possessing  a  bitter  ex- 
tractive principle,  and  the  latter  uniting  astringent  with  tonic 
properties,  and,  in  the  case  of  preparations  of  iron,  increas- 
ing the  red  coloring  matter  of  the  blood.  Such  agents  as  gentian, 
quassia,  calumba,  wild  cherry,  serpentaria,  cinchona  and  its 
alkaloid  quinine,  salix,  pepsin,  are  examples  of  vegetable  tonics ; 
and  the  preparations  of  iron,  preparations  of  copper,  preparations 
of  zinc,  and   such   agents   as  subnitrate  of  bismuth,   sulphuric, 


REMEDIAL   AGENTS.  81 

nitric,  muriatic   and   oxalic  acids,  are  examples  of  the  mineral 
tonics. 

ASTRINGENTS. 

Astringents  are  medicinal  agents  which  produce  contraction  of 
the  tissues,  having  a  corrugating  power,  either  directly  exerted  on 
a  part,  or  extended  by  sympathetic  action,  and  thus  removing 
morbid  affections  arising  from  a  state  of  relaxation,  such  as  in- 
flammation of  superficial  parts,  hemorrhage  and  excessive  dis- 
charges from  mucous  membranes.  This  class  of  remedies  is 
irnportant  in  dental  practice,  owing  to  their  great  efficacy  as  an- 
tiphlogistics.  Astringents  are  divided  into  vegetable  and  rnineral^ 
the  former  owing  their  peculiar  property  of  astringency  to  the 
presence  of  tannic  acid,  while  the  latter  possess  a  more  decided 
astringency,  and  exert  a  sedative  action  on  the  vascular  system. 
In  the  treatment  of  affections  of  the  mucous  membrane,  such  as 
stomatitis^  the  object  is  to  arrest  the  inflammatory  action,  which 
is  accomplished  by  the  power  of  the  astringent  remedies  em- 
ployed locally  to  increase  the  tonicity  of  the  tissue,  and  to  dimin- 
ish the  calibre  of  the  vessels  supplying  the  part  with  blood,  thus 
diminishing  the  quantity  required  for  the  production  of  the  mor- 
bid action.  Besides  diminishing  the  current  of  the  blood  to  the 
inflamed  part,  astringents  also  exert  an  influence  on  the  pores  or 
ducts  through  which  the  discharge  is  poured  out,  by  diminishing 
their  calibre.  Astringents  also  exert  an  influence  on  mor- 
bidly relaxed  tissues,  when  such  a  condition  results  as  the  sequelae 
of  disease,  especially  in  lymphatic  temperaments,  where  flabbiness 
of  the  soft  tissues  is  characteristic. 

Care,  however,  is  necessary  in  the  use  of  astringents,  for  when 
long  or  immoderately  used  they  may  act  as  direct  irritants,  in- 
ducing inflammation  followed  by  ulceration  and  sloughing.  They 
are  contraindicated  for  the  arrest  of  evacuations  that  are  desig- 
nated by  nature  to  relieve  a  plethoric  state  of  the  system,  unless 
such  evacuations  exist  to  an  alarming  extent.  This  class  of 
remedies  can  be  readily  detected  bv  the  taste,  as  they  convey  a 
sense  of  roughness  to  the  palate  which  cannot  be  mistaken,  and 
which   is  more  marked  in  some  substances  than  in  others.     Such 

agents  as  tannic  acid,  gallic  acid,  nutgall,  matico,  kino,  catechu, 
6 


82  DENTAL  MEDICINE. 


rhatany,  white  oak  bark,  creasote,  salicylic  acid,  are  examples  of 
the  vegetable  astringents ;  while  the  preparations  of  iron  and 
lead,  alum,  sulphuric  and  nitric  acids  are  examples  of  the  mineral 
astringents.     (See  Styptics.) 

STIMULANTS. 

Stimulants,  also  known  as  excitants  and  hypersthenics^  are  medic- 
inal substances  capable  of  exciting  a  temporary  and  rapid  exalta- 
tion of  the  organic  actions,  the  excitation  thus  produced  being 
extended  or  not  to  the  rest  of  the  system.  Although  the  stomach 
is  the  organ  generally  selected  in  medical  practice  to  be  the 
first  impressed  by  stimulants,  on  account  of  the  extensive  sym- 
pathy which  exists  between  it  and  the  rest  of  the  system,  in 
dental  practice  these  agents  are  topically  applied  to  the  mucous 
membrane  of  the  mouth  as  counter-irritants  and  vesicants.  The 
influence  of  stimulants  is  most  apparent  in  conditions  of  morbid 
depression,  whereas  in  health  they  soon  induce  depression.  They 
possess  the  power  of  arousing  the  energies  of  the  nervous  system, 
and  hence  are  beneficial  in  many  nervous  disorders,  especially 
those  of  a  spasmodic  nature.  When  applied  to  the  gastro-intes- 
tinal  canal  they  promote  digestion  as  stomachics^  and  when  ad- 
ministered to  dispel  flatulence  they  are  known  as  carminatives. 
When  internally  administered,  it  is  for  the  most  part  advisable  to 
begin  with  small  doses,  and  increase  them  as  circumstances  may 
require.  In  some  cases,  however,  it  is  necessary  to  give  them 
freely  from  the  first.  It  is  often  requisite  to  change  the  stimu- 
lating substance  and  also  the  part  of  the  body  to  which  it  is 
applied  ;  when  the  stomach  fails,  the  rectum  and  skin  may  be 
acted  upon  beneficially.  Topically  applied,  stimulants  irritate 
and  inflame  the  parts  with  which  they  come  in  contact,  and  are 
then  known  as  irritants. 

The  most  powerful  and  rapid  stimulants  are  known  as  dijffli- 
sible.,  while  others  of  a  vegetable  nature,  containing  a  volatile  oil, 
are  termed  aromatic.  Among  the  class  of  diffusible  stimulants 
are  such  agents  as  alcohol,  preparations  of  ammonia,  arnica, 
phosphorus,  etc.,  etc.  Among  the  class  of  aromatic  stimulants 
arc  capsicum,  cinnamon,  black  pepper,  mace,  cloves,  pimento,  oil 


REMEDIAL   AGENTS..  §3 


of  turpentine,  ginger,  cardamom,  calamus,  gaultheria,  peppermint, 
origanum,  etc.,  etc. 

SEDATIVES. 

S^atives  are  medicinal  substances  employed  to  diminish  the 
frequency  of  the  action  of  the  circulation,  their  therapeutic 
influence  being  due,  it  is  thought,  to  a  stimulant  character. 
They  reduce  vascular  excitement,  and  while  relieving  irritability 
and  irregularity  of  the  heart's  action,  their  first  effect  is  to  restore 
its  tone  and  force  when  it  is  in  a  morbidly  depressed  condition. 
Substances  known  as  refrigerants^  which  possess  the  power  of 
diminishing  febrile  heat,  allaying  thirst,  restoring  the  secretions, 
and  which  comprise  almost  all  of  the  neutral  alkaline  salts,  are 
also  included  with  sedatives.  Among  the  class  known  as  seda- 
tives are  digitalis,  American  hellebore  (veratrum  viride),  white 
hellebore  (veratrum  album),  yellow  jasmine  (gelsemium),  tartar 
emetic,  nitrate  of  potassium,  etc.,  etc.  Among  the  class  known 
as  refrigerants  are  borate  of  soda,  citrate  of  potassium,  acetate  of 
ammonia,  spirit  nitrous  ether,  and  vegetable  acids. 

SPINANTS. 

Spinants  or  spastics  are  medicinal  substances  employed  to 
excite  muscular  contraction.  Vegetable  spinants  containing  the 
alkaloids  strychnia  and  brucia,  and  employed  therapeutically  in 
cases  of  torpid  and  paralytic  conditions  of  the  muscular  system, 
are  the  most  important  of  this  class  ;  also  ergot,  which  is  em- 
ployed to  excite  muscular  contraction  of  the  uterus.  Among  the 
class  of  spinants  are  such  agents  as  nux  vomica,  and  its  alkaloid 
strychnine,  ignatia,  cotton-root  bark,  ergot. 

EMETICS. 

Emetics  are  medicinal  substances  which  excite  vomiting,  their 
action  being  independent  of  any  effect  arising  from  the  quantity 
of  the  agent  introduced  into  the  stomach. 

While  the  action  of  an  emetic  is  local  as  regards  the  stomach, 
it  extends  to  almost  every  organ  of  the  body,  and  in  order  that  a 
substance  of  this  kind  shall  produce  its  effect  upon  the  stomach, 
it  must  first  make  an  impression  upon  the  cerebro-spinal  axis. 
Within  fifteen  or  twenty  minutes  after  an  emetic  is  administered 


84  DENTAL  MEDICINE. 


there  is  experienced  a  feeling  of  distress,  relaxation  and  faintness^ 
with  a  cool,  moist  skin  and  small,  feeble  and  irregular  pulse,  such 
symptoms  increasing  until  emesis  occurs  ;  during  which  the  face 
becomes  flushed,  the  pulse  full  and  frequent,  with  an  increase  in 
the  temperature  of  the  body.  When  the  action  of  vomiting  is 
over,  the  skin  again  becomes  moist,  the  pulse  soft  and  feeble, 
and  a  languid  and  drowsy  feeling  is  experienced.  Whatever 
may  be  the  apparent  necessity  for  evacuating  the  stomach,  all  the 
circumstances  of  the  case  must  be  considered,  and,  especially  if 
there  be  much  arterial  excitement,  with  determination  to  the 
head,  blood-letting  should  sometimes  be  premised. 

When  the  full  dose  of  an  emetic  is  requisite,  as  in  cases  of 
poisoning,  the  object  is  to  evacuate  the  contents  of  the  stomach 
as  speedily  as  possible  ;  but  in  other  cases  it  is  better  to  adminis- 
ter the  emetic  substance  in  divided  doses,  frequently  repeated, 
until  the  desired  effect  is  produced. 

In  cases  of  torpor  or  congestion,  it  is  sometimes  necessary  to 
arouse  the  system  by  retching  or  vomiting,  which  may  be  done 
by  administering  the  emetic  with  only  a  small  quantity  of  fluid  ; 
but  when  the  object  is  to  empty  the  stomach,  and  duodenum 
merely,  free  draughts  of  tepid  water  or  weak  chamomile  tea  may 
be  given  as  sopn  as  nausea  occurs.  When  the  excitability  of  the 
stomach  is  greatly  diminished  by  a  narcotic,  as  in  cases  of  poison- 
ing, it  is  necessary  to  assist  the  emetic  by  the  addition  of  some 
excitant.  Vinegar,  mustard  or  ammonia  answer  as  excitants, 
when  such  an  effect  is  caused  by  opium  ;  but  the  stomach-tube 
is  the  best  resource. 

There  are  some  few  cases  where  emetics  cannot  be  employed 
with  safety,  as  in  congestion  of  the  brain,  a  great  determination 
of  blood  to  the  head  dependent  upon  constitutional  causes,  preg- 
nancy, hernia,  active  hemorrhage  from  the  lungs  and  uterus, 
acute  gastritis,  etc.,  etc. ;  and  if  emetics  are  allowable  in  such 
diseases  or  conditions,  it  is  in  nauseating  doses  only.  When 
they  are  used  merely  to  excite  nausea,  they  are  termed  nauseants. 

Emetics,  by  frequent  use,  are  prone  to  cause  an  increased  sus- 
ceptibility of  the  stomach  to  their  action  ;  hence,  persons  of  deli- 
cate habits  should  use  them  cautiously. 


REMEDIAL   AGENTS.  85 

Therapeutically,  emetics  are  employed  to  evacuate  the  stomach 
in  cases  of  poisoning,  undigested  food,  etc.,  to  expel  foreign  sub- 
stances from  the  throat  or  oesophagus  ;  to  excite  nausea,  in  order 
to  depress  the  vascular  and  muscular  systems ;  to  relieve  spasm  ; 
to  promote  secretion  and  excretion,  and  to  make  decided  impres- 
sions in  the  forming  stages  of  certain  fevers  and  delirium 
tremens. 

To  relieve  excessive  vomiting,  resulting  from  the  use  of  emetics, 
ice  broken  in  small  pieces  and  swallowed  ;  lime  water  and  milk 
(a  teaspoonful  of  each,  mixed  cold  and  given  at  intervals  of  15 
or  20  minutes) ;  a  drop  of  creasote  in  a  wineglass  of  water  (a 
tablespoonful  given  every  15  or  20  minutes);  ^  drop  of  diluted 
hydrocyanic  acid  in  syrup  and  water,  or  in  syrup  of  wild  cherry 
bark  (given  every  15  minutes)-,  or  infusion  of  camphor  (made 
with  boiling  water  and  given  cold,  a  teaspoonful  frequently  re- 
peated);  brandy  and  water;  clove  or  green  tea;  an  anodyne  in- 
jection ;  counter-irritant  to  the  stomach  (as  a  mustard  plaster,  a 
hot  fomentation  of  brandy  and  clove  or  spice  plaster). 

Among  the  class  of  vegetable  emetics  are  ipecacuanha,  san- 
guinaria,  mustard,  lobelia,  tobacco,  squill ;  and  mineral  emetics, 
such  as  sulphate  of  zinc,  sulphate  of  copper,  tartar  emetic,  alum, 
common  salt,  turpeth  mineraL 

CATHARTICS. 

Cathartics  or  purgatives  are  medicinal  agents  which  evacuate 
the  bowels,  and  are  capable  of  fulfilling  three  different  indica- 
tions :  I.  Simply  to  evacuate  the  bowels.  2.  To  excite  an  in- 
creased discharge  from  the  mucous  coat  of  the  intestines,  and  3. 
To  stimulate  the  neighboring  viscera  and  cause  them  to  secrete 
a  greater  quantity  of  their  peculiar  fluids.  When  they  produce 
watery  discharges  by  stimulating  the  mucous  follicles  and  ex- 
halants,  they  are  termed  h\dragogues.  When  given  in  overdoses 
they  are  so  powerful  as  to  produce  violent  vomiting  and  purging, 
pain  in  the  abdomen,  cold  extremities  and  a  sinking  pulse.  Sev- 
eral diff^erent  cathartics  are  usually  combined  in  one  formula,  when 
it  is  desired  to  produce  all  of  the  indications  above  referred  to. 
Some  agents  of  this  class   produce   their  effect  by  absorbing  the 


86  DENTAL  MEDICINE. 


acid  generated  in  the  alimentary  canal,  thus  becoming  converted 
into  a  purgative  salt,  as  magnesia,  for  example.  Others  expend 
their  principal  force  upon  the  rectum  and  large  intestines,  and  for 
this  reason  are  advantageously  employed  in  affections  of  the 
lower  bowels,  and  the  uterus  and  its  appendages,  such  as  aloes, 
for  example.  Cathartics  should  always  be  given  on  an  emptv 
stomach.  If  administered  immediately  after  a  full  meal,  they 
arrest  the  digestive  process,  are  liable  to  cause  nausea,  if  not 
vomiting,  and  do  not  evacuate  the  bowels  with  the  same  certainty 
or  effect. 

When  simple  costiveness  is  to  be  removed,  the  cathartic  may 
be  administered  in  the  evening,  and,  if  not  sufficient,  the  dose 
can  be  repeated  in  the  morning  and  at  regular  intervals  through 
the  day,  until  the  effect  is  produced. 

In  administering  cathartics,  the  excitement  is  to  be  continued 
till  the  requisite  action  is  induced,  yet  not  sufficient  to  prove  an 
irritant.  But  in  the  treatment  of  many  diseases,  it  is  preferable 
to  pui^e  through  the  day,  in  order  that  the  sleep  may  not  be  dis- 
turbed at  night.  The  operation  of  cathartics  may  be  ver\-  much 
accelerated  by  the  free  use  of  diluent  drinks,  such  as  gruel,  bar- 
ley water,  etc.,  etc.  By  combining  these  remedies,  the  action  of 
many  of  them  is  modified  and  controlled;  and  some  of  the  more 
powerful  mav  be  made  to  operate  mildly  and  certainly  by  uniting 
small  quantities  of  several  of  them  in  the  same  dose. 

The  addition  of  an  emetic  substance,  such  as  ipecacuanha,  or 
tartar  emetic,  gives  activity  to  the  combination,  while  it  modifies 
the  harshness  of  the  powerful  cathartics. 

The  operation  of  a  cathartic  may  often  be  promoted  by  judi- 
cious venesection,  and  if  there  is  spasm  of  the  intestines,  opium 
may  be  advantageously  added  to  the  cathartic. 

Cathanics  act  not  only  upon  the  bowels,  but  upon  distant 
parts,  as  every  portion  of  the  organism  is  capable  of  being  im- 
pressed by  them.  Cathartics  are  divided,  according  to  the  in- 
tensity of  their  operation,  into  laxatives^  purgatives  and  drastics^ 
to  which  may  also  be  added  enemata.  Laxatives  gentlv  stimulate 
the  mucous  coat  of  the  intestines,  and  hence  they  are  well 
adapted  for  cases  in  which  the  sole  indication  is  to  unload  the 


REMEDIAL   AGENTS.  87 

bowels  of  their  contents.  Purgatives  are  more  powerful  in  their 
operation ;  they  excite  a  copious  exhalation  from  the  mucous 
lining  of  the  intestines,  and  augment  the  peristaltic  action  to  a 
great  degree.  Drastics  are  the  more  powerful  and  violent  cathar- 
tics, and  produce  a  greater  degree  of  irritation  in  the  lining  mem- 
branes of  the  intestines,  and  occasionally  act  upon  the  nerves  of 
the  stomach,  so  as  to  cause  nausea  and  sometimes  vomiting. 
Drastics  generally  belong  to  the  resino-extractive  substances,  and 
act  violently,  on  account  of  being  sparingly  soluble  and  adhering 
to  the  mucous  coat  of  the  intestines. 

Enemata  are  agents  of  this  class  which  act  on  the  lower  part 
of  the  intestinal  tube  by  direct  application  ;  they  irritate  the  lining 
membrane  of  the  rectum,  and  by  sympathy  of  continuity,  their 
influence  is  extended  to  the  intestinal  canal.  Hence  enemata 
may  be  employed  with  advantage  when  cathartics  cannot  be  given 
by  the  mouth,  as  when  deglutition  is  impracticable.  What  are 
known  as  saline  cathartics  are  employed  in  the  treatment  of  febrile 
and  inflammatory  affections,  as  they  do  not  produce  any  excitant 
action  on  the  general  system.  There  are  also  acrid  cathartics^ 
which  are  not  violent  enough  to  cause  inflammation.  Others  are 
known  as  mercurial  cathartics.  The  class  known  as  laxatives 
comprise  such  substances  as  certain  articles  of  diet,  as  ripe  and 
dried  fruits,  such  as  tamarinds,  peaches,  raisins,  figs,  prunes,  also 
molasses,  honey,  cracked  wheat,  Indian  meal  and  oatmeal,  etc., 
etc.  Other  laxatives  are  castor  oil,  manna,  sulphur,  purging 
cassia,  etc.,  etc.  Saline  cathartics  comprise  such  substances  as 
magnesia,  carbonate  and  sulphate  of  magnesia  (Epsom  salts), 
solution  of  citrate  of  magnesia,  sulphate  of  sodium  (Glauber's 
salt),  solution  of  manganese,  phosphate  of  sodium,  sulphate  of 
potassium,  cream  of  tartar,  soluble  tartar,  Rochelle  salts.  Mild., 
acrid  cathartics  comprise  such  substances  as  rhubarb,  aloes,  senna, 
leptandra,  elder.  Drastic  cathartics  comprise  such  substances  as 
jalap,  may  apple,  scammony,  colocynth,  gamboge,  elaterium, 
croton  oil.  Mercurial  cathartics  consist  of  calomel,  blue  mass, 
mercury  with  chalk.  Enemata  consist  of  tepid  water,  flaxseed 
tea  or  other  demulcent  infusion  ;  a  combination  of  a  teaspoonful 
each  of  common  salt,  molasses  and  lard  or  olive  oil,  in  two-thirds 


88  DENTAL  MEDICINE. 


of  a  pint  of  warm  water,  to  which  castor  oil  or  Epsom  salt  may 
be  added  to  augment  the  cathartic  effect,  is  a  formula  for  the  com- 
mon laxative  enema.     (See  Purgatives.) 

DIAPHORETICS. 

Diaphoretics,  known  also  as  sudorijics^  are  medicinal  substances 
capable  of  producing  perspiration,  or  an  increase  of  the  cutaneous 
discharge,  which  may  be  occasioned  by  the  mere  drinking  of  a 
large  quantity  of  fluid,  provided  the  temperature  of  the  system 
be  kept  up.  The  determination  of  blood  to  the  cutaneous  ves- 
sels by  a  warm  temperature  or  exercise  will  produce  diaphoresis, 
and  the  action  of  nauseating  agents,  by  relaxing  the  orifices  of 
the  cutaneous  vessels,  and  also  stimulants,  by  exciting  such  ves- 
sels to  increased  secretion,  will  have  the  same  effect. 

The  external  application  of  heat,  friction,  etc.,  stimulates  the 
cutaneous  capillaries  and  causes  an  increased  secretion. 

Diaphoresis  may  also  be  excited  by  medicines  which  enter  the 
circulation  and  stimulate  the  cutaneous  vessels  by  contact,  such 
as  the  mercurials  and  sulphur;  also  by  medicines  which  act  on 
the  surface  sympathetically,  through  the  medium  of  the  stomach, 
as  cold  drinks,  etc. 

Diaphoresis  may  also  be  produced  by  increasing  the  general 
action  of  the  vascular  system,  by  such  means  as  violent  exercise, 
the  warm  bath,  and  by  the  use  of  alcohol,  ammonia,  guaiacum, 
etc. ;  it  may  also  be  produced  by  the  use  of  agents,  capable  of 
relaxing  the  morbidly  constricted  mouths  of  the  perspiratory  ves- 
sels, such  as  the  antimonials,  saline  diaphoretics,  and  by  the  op- 
eration of  venesection. 

Nauseating  diaphoretics  are  employed  to  produce  a  powerful 
relaxing  action  in  inflammatory  cases  not  complicated  with  gas- 
tric irritability,  and  for  such  effects  the  emetics  ipecacuanha  and 
the  preparations  of  antimony  are  administered. 

Refrigerant  diaphoretics  are  employed  to  produce  a  gentle  relax- 
ing effect  in  allaying  febrile  excitement  and  reducing  the  tempera- 
ture of  the  body. 

Stimulating  diaphoretics  are  employed  in  rheumatic  and  pul- 
monary  affections,  after   vascular  excitement   has  been  reduced. 


REMEDIAL   AGENTS.  89 


and  where  the  surface  is  cool,  being  contra! ndicated  in  a  high  de- 
gree of  inflammation.  For  such  effects,  the  diffusible  stimulants, 
aromatic  substances,  and  such  narcotics  as  opium  and  camphor 
are  administered.  During  the  administration  of  diaphoretics,  the 
patient  should  be  confined  to  bed,  and  when  diaphoresis  is  ex- 
cited, it  should  not  be  suddenly  checked.  Venesection  is  gener- 
ally resorted  to  when  there  is  great  arterial  excitement  with  undue 
heat  of  skin,  before  the  attempt  is  made  to  administer 
diaphoretics. 

Belonging  to  the  class  of  diaphoretics  are  such  agents  as 
Dover's  powder,  guaiac,  spirits  of  mindererus,  nitrate  of  potassa, 
sweet  spirit  of  nitre,  etc.,  etc, 

DIURETICS. 

Diuretics  are  medicinal  substances  which  act  upon  the  kidneys, 
and  produce  an  increased  flow  of  urine. 

Remedies  of  this  class  act  immediately  and  specially  upon  the 
kidneys,  some  reaching  these  organs  by  first  passing  through  the 
blood,  without  being  decomposed,  while  others,  on  the  contrary, 
undergo  changes  in  the  first  passages,  the  result  of  such  changes 
exciting  diuresis.  The  principal  use  of  diuretics  is  to  promote 
the  absorption  of  dropsical  effusions.  They  are  also  employed  to 
correct  nephritic  disorders,  accompanied  with  obstructed  secretion 
in  calculi  of  the  kidneys,  ureters  and  bladder,  and,  as  evacuants, 
to  reduce  inflammation. 

Where  there  is  great  arterial  excitement,  a  judicious  use  of  a 
lancet  is  recommended,  prior  to  the  administration  of  diuretics, 
the  patient  being  kept  cool,  to  avoid  perspiration. 

To  insure  the  full  effect  of  diuretics,  diluent  drinks  should  be 
freely  given,  and  especially  such  as  contain  some  diuretic  sub- 
stance. Included  in  the  class  of  diuretics  are  such  agents  as 
squill,  nitre,  cubebs,  juniper,  colchicum,  erigeron,  cream  of  tar- 
tar, copaiba,  podophyllum,  etc.,  etc. 

BLENNORRHETICS. 

Blennorrhetics  are  medical  substances  which  increase  the  secre- 
tion  of  the   mucous   membianes,  and    are  employed    in    morbid 


90  DENTAL  MEDICINE. 

conditions  of  such  membranes,  in  order  to  restore  them  to  healthy 
action,  in  cases  where  their  secretion  is  deficient,  excessive  or 
abnormal  in  quality.  They  are  termed  expectorants  when  used 
to  stimulate  the  secretion  of  mucus  from  the  bronchial  or  laryn- 
geal membranes,  as  in  bronchitis  and  laryngitis,  and  during  con- 
valescence, in  pneumonia.  The  oleo-resinous  agents  of  this 
class  are  employed  in  chronic  diarrhoea,  and  the  diarrhoea  of 
typhoid  fever,  such  as  oil  of  turpentine,  for  example;  also  in  dis- 
eases of  the  urino-genital  mucous  membranes,  such  as  gonorrhea, 
gleet,  leucorrhea,  incontinence  of  urine,  cystitis,  etc.,  etc.  In- 
cluded in  the  class  of  blennorrhetics  are  such  agents  as  senna, 
cimicifuga,  garlic,  turpentine,  squill,  copaiba,  cubebs,  matico, 
buchu,  myrrh,  benzoin,  storax,  balsam  of  peru,  balsam  of 
tolu,  etc.,  etc. 

EMMENAGOGUES. 

Emmenagogues  are  medicinal  substances  which  promote  the 
menstrual  discharge,  or  restore  it  when  entirely  suppressed.  The 
particular  emmenagogue  required  depends  upon  the  cause  of  the 
amenorrhea;  for  example,  when  anemia  is  the  cause,  the  prepara- 
tions of  iron  prove  most  effectual;  when  from  plethora,  blood 
letting  and  cathartics  or  evacuants  are  resorted  to.  Certain 
medicinal  substances  excite  the  pelvic  circulation,  and  stimulate 
the  parts  in  direct  connection  with  the  uterus,  and  thereby  in- 
crease or  promote  the  menstrual  discharge. 

General  debility  being  the  cause  of  the  local  affection,  an 
active  administration  of  tonics,  in  connection  with  the  emmen- 
agogue required,  is  advisable. 

The  most  prominent  of  this  class  of  emmenagogues  are 
savine,  .cantharides,  ergot,  cotton  root,  Seneca,  snake  root, 
guaiacum,  etc.,  etc. 

HEMATINICS. 

Hematinics  are  medicinal  substances  which  increase  the  num- 
ber of  blood  corpuscles,  or  the  amount  of  hematin  in  the  blood, 
and  hence  are  administered  in  such  diseases  as  are  dependent  on 
a  deficiency  of  these  elements. 


REMEDIAL   AGENTS.  91 


This  class  of  remedies  includes  the  preparations  of  iron  or 
chalybeates,  which  are  capable  of  causing  changes  in  the  condi- 
tion of  the  blood,  and  also  general  and  local  tonic  effects. 


ALTERATIVES. 


Alteratives  are  medicinal  substances  which  are  capable,  when 
administered  in  small  doses,  of  removing  morbid  structures  and 
conditions,  without  any  sensible  evacuation ;  in  other  words, 
changing,  in  some  inexplicable  and  insensible  manner,  certain 
morbid  actions  of  the  system. 

Alterative  remedies  re-establish  the  healthy  functions  of  the 
animal  economy  in  a  slow  but  decided  manner,  acting  on  the 
various  secreting  organs,  sometimes  without  any  sensible  increase 
of  the  secretions  themselves.  The  effect  of  minute  doses  of 
mercury,  iodine  and  other  substances,  upon  the  glandular  appa- 
ratus, affords  examples.  Medicinal  remedies  of  almost  every  class 
become  alteratives  by  being  administered  in  very  small  doses,  at 
intervals  of  a  few  hours ;  and  they  are  generally  classed  with 
stimulants  and  tonics,  and  some  of  them  with  narcotics.  By 
their  action  the  secretions  and  exhalations  are  increased ;  the 
exudation  of  plastic  or  coagulable  lymph  is  diminished ;  the 
formation  of  false  membranes  checked  ;  the  textures  softened ; 
inflammatory  action  arrested  ;  and  morbid  growths  and  deposits 
absorbed.  Phlegmonous  inflammation  is  arrested,  and  visceral 
and  glandular  enlargements  are  dispelled.  But  if  administered 
too  freely,  the  blood  may  become  so  impoverished  as  to  interfere 
with  the  functions  of  nutrition,  and  a  marasmatic  or  cachetic 
condition  be  produced,  the  textures  being  softened,  or  even 
destroyed.  Hence  this  class  of  remedies  should  be  carefully 
administered,  and  their  effects  be  closely  observed.  The  chief 
use  of  alteratives  is  antiphlogistic  or  resolvent ;  for  example, 
the  mercurials  are  generally  employed  in  acute  inflammation, 
and  the  preparations  of  iodine  and  bromine  in  chronic  inflam- 
mations. 

Included  in  this  class  are  the  preparations  of  mercury,  iodine, 
iodide  of  potassium,  iodoform,  bromine  preparations  of 
arsenic,  phosphate  and  hypophosphite  of  lime,  chlorate  of  potas- 


92  DENTAL  MEDICINE. 


slum,  permanganate   of   potassium,   chlorine   water,   chlorinated 
lime,  etc.,  etc. 

ANTACIDS. 

Antacids  are  medicinal  substances,  capable  of  neutralizing 
acidity  of  the  blood,  the  secretions,  etc.,  by  combining  with  the 
acid  and  counteracting  it. 

The  alkalies,  alkaline  earths,  and  their  carbonates  are  the  sub- 
stances included  in  this  class,  and  the  former  are  more  energetic 
in  their  action  than  the  alkaliije  earths,  such  as  magnesia.  The 
carbonates  of  these  earths  have  little  or  no  chemical  influence 
upon  the  tissues. 

This  class  of  remedies,  in  the  form  of  alkaline  preparations, 
are  administered  internally  as  antacids  in  cases  where  an  unusual 
quantity  of  acid  is  generated  in  the  stomach — a  common  symp- 
tom of  dyspepsia,  which  is  indicated  by  acid  eructations,  violent 
heartburn  and  marked  effervescence  when  a  carbonated  alkali  is 
taken ;  the  acid  in  the  stomach  laying  hold  of  the  alkaline  base, 
and  resulting  in  a  large  quantity  of  carbonic  acid  being  driven 
ofF. 

Alkalies  are  also  employed  to  relieve  irritability  of  the  stomach 
and  check  vomiting ;  also  as  antidotes  in  cases  of  poisoning  from 
acids  ;  also  as  antilithics^  to  neutralize  lithic  acid  when  it  is  sep- 
arated in  unusual  quantity  by  the  urinary  secretion ;  also  as 
lithontriptics^  or  solvents  of  calculi,  more  particularly  lithates  ; 
also  employed  in  cases  of  acute  rheumatism  and  gout,  to  neutral- 
ize the  excess  of  acid  in  the  blood  ;  also  in  diabetes  mellitus,  and 
to  relieve  irritability  of  the  urinary  organs,  cutaneous  irritation, 
itching  of  the  anus,  especially  when  such  conditions  are  depend- 
ent on  an  excess  of  acid  in  the  system  ;  and  also  as  antiplastics 
and  resolvents  in  inflammation,  and  as  diuretics.  As  a  general 
rule  the  administration  of  antacids  should  be  preceded  by  an 
emetic  or  cathartic,  and  in  some  cases  both. 

When  a  permanent  effect  is  desired,  antacids  are  usually  com- 
bined with  tonics  and  aromatics,  and  occasionally  with  narcotics  ; 
for  when  given  alone  the  relief  afforded  is  but  transient.  To 
prevent  an  irritant  and  purgative  action  on  the  bowels,  and  also 


REMEDIAL   AGENTS.  93 


to   facilitate  their  absorption,  antacid  preparations  are  adminis- 
tered in  a  state  of  large  dilution. 

In  dental  practice  antacids  are  also  employed  for  correctino; 
acidity  of  the  fluids  of  the  mouth,  often  a  result  of  acid  eructa- 
tions from  the  stomach.  The  class  of  antacids  comprise  the 
preparations  of  potassium,  sodium,  lithium,  ammonium,  mag- 
nesium and  calcium.  The  antacids  employed  in  dental  practice 
are  principally  precipitated  chalk,  lime  water,  carbonate  of  soda, 
etc. 

IRRITANTS. 

The  medicinal  substances  recognized  as  irritants  are  subdivided 
into  rubefacients^  epispastics^  suppurants  and  escharotics. 

Rubefacients  are  agents  employed  to  redden  the  surface  by 
exciting  the  action  of  the  capillaries,  and  occasioning  an  afflux 
of  vascular  and  nervous  power  to  the  part  with  which  they  come 
in  contact;  hence  pain  is  a  usual  consequence  of  their  employ- 
ment. 

Thev  are  used  for  the  same  purposes  as  blisters,  and  are  often 
a  good  substitute  for  them;  for  example,  in  low  degrees  of  in- 
flammation, as  local  anodynes,  as  general  stimulants  ;  their  effi- 
cacy as  such  depending  upon  their  action  on  the  capillary  circu- 
lation, and  also  on  the  pain  they  occasion.  They  are  especially 
serviceable  in  the  coma  and  asphyxia  resulting  from  poisons  and 
drowning,  but  in  cases  of  cerebral  oppression  are  inferior  to 
blisters.  Rubefacients  are  used  until  redness  and  pain  occur, 
but  their  persistent  application  will  cause  vesication,  and  even 
gangrene. 

In  the  class  of  rubefacients  are  included  mustard,  capsicum, 
oil  of  turpentine,  ammonia,  liniment.  Burgundy  pitch,  Canada 
pitch,  ginger,  black  pepper,  garlic  and  spice  plaster. 

Epispastics,  also  called  vesicants  and  blisters^  are  medicinal 
agents,  capable  of  producing,  when  applied  to  the  skin,  inflam- 
mation followed  by  an  effusion  of  serum  beneath  the  cuticle. 
As  a  general  rule,  blisters  should  remain  on  the  surface  of  the 
skin  six  or  eight  hours,  in  order  to  insure  their  full  effect.  When 
the  skin   is  very  delicate  a  shorter  application  will  answer  every 


94  DENTAL  MEDICINE. 


purpose ;  and  in  the  case  of  children  it  is  seldom  necessary  for 
them  to  remain  longer  than  three  or  fours  hours.  When  applied 
to  the  scalp,  twelve  hours  are  generally  required.  After  remov- 
ing a  blister,  the  usual  dressing  is  some  non-irritating  ointment, 
such  as  simple  cerate.  In  acute  diseases,  blistering  ought  never 
to  precede  such  means  as  have  a  tendency  to  reduce  inflamma- 
tory action,  and  the  application  should  be  as  near  the  affected 
part  as  possible. 

Covering  blisters  with  fine  gauze  renders  them  much  less 
irritating,  and  does  not  retard  their  operation. 

If  a  blister  is  applied  long  enough  to  redden  the  skin,  a  simple 
poultice  will  complete  the  vesication  ;  and  in  the  case  of  children 
this  method  should  always  be  pursued.  When  it  is  necessary  to 
keep  the  blister  open,  weak  epispastic  or  savin  ointment  will 
prove  sufficient.  When  the  circulation  is  languid  in  the  ex- 
tremities, they  seldom  act  efficiently,  and  may  cause  gangrene 
by  exhausting  what  vitality  remains.  When  strangury  is  pro- 
duced, the  blister  must  be  removed  after  three  or  four  hours,  and 
the  part  bathed  with  olive  oil,  or  a  poultice  applied,  and  diluent 
drinks  used;  an  opium  suppository  or  injection  will  prove  serv- 
iceable. Epispastics  are  employed  as  local  stimulants  in  the 
treatment  of  inflammations ;  to  create  a  healthy  inflammatory 
action,  as  in  various  cutaneous  eruptions ;  to  relieve  pain ;  to 
destroy  morbid  associations  by  causing  a  powerful  impression  ; 
to  stimulate  the  absorbing  or  secreting  vessels  of  parts  in  the 
neighborhood  of  the  affected  part  -,  to  stimulate  generally ;  to 
relieve  threatened  gangrene  and  paralysis  ;  to  produce  local  de- 
pletion as  evacuants,  and  to  prepare  a  surface  for  the  cndermic 
application  of  medicines. 

The  class  of  epispastics  include  such  agents  as  cantharides, 
cantharidal  collodion,  water  of  ammonia,  etc. 

SuppURANTS  are  medicinal  agents,  which,  when  rubbed  on  the 
skin,  cause  rubefaction,  accompanied  by  a  pustular  eruption ; 
their  beneficial  effects  being  due  to  the  counter-irritation  set  up. 
The  agents  of  this  class  are  generally  employed  in  subacute, 
chronic  laryngeal  and  bronchial  affections,  diseases  of  the  joints, 
etc.,  etc. 


REMEDIAL   AGENTS.  95 


Included  as  suppurants  are  croton  oil,  antimonial  ointments, 
etc.,  etc. 

EscHAROTics,  called  also  Cauterants  or  Caustics^  are  medicinal 
agents  capable  of  destroying  the  structure  and  vitality  of  the  parts 
with  which  they  come  in  contact,  producing  an  eschar  or  slough, 
which  is  followed  by  inflammation  and  suppuration  of  the  neigh- 
boring tissues  to  such  a  degree  that  the  slough  separates  from  the 
living  parts.  The  mode  of  action  of  an  escharotic  is  as  follows : 
After  being  applied  to  the  skin,  so  as  to  chemically  disorganize 
it,  or  destroy  its  vitality,  a  new  action  is  set  up  in  the  vessels 
beneath  the  slough,  so  as  to  cause  it  to  be  thrown  off.  The  ex- 
cavation resulting  is  then  kept  open  by  inserting  some  irritant, 
which  maintains  a  copious  secretion  of  pus  from  the  ulcerated 
surface.  Escharotics  are  divided  into  Jctual  and  Poterjtial ;  the 
actual  being  fire  itself,  while  the  potential  are  substances  which 
destroy  the  living  solids,  either  by  excessive  stimulation,  or  by 
producing  a  chemical  decomposition. 

Iron  heated  to  a  white  heat  and  the  Jiioxa  (cones  or  cylinders 
of  inflammable  substance)  represent  the  actual  cautery ;  and 
caustic  potash,  nitrate  of  silver,  burnt  alum,  chloride  of  zinc, 
chromic,  sulphuric  and  nitric  acids,  and  the  nerve  or  arsenical 
paste  employed  in  dental  practice,  represent  the  potential  cautery. 
A  sub-class  is  composed  of  what  are  known  as  Issues  and  Setons; 
the  blister  issue^  where  the  skin  is  removed  by  a  blister,  and  the 
discharge  promoted  by  means  of  stimulating  applications,  as  the 
cantharidal  ointment,  for  example ;  also,  the  pea  issue^  where  an 
incision  made  by  the  lancet  is  kept  open  by  means  of  a  pea,  beet, 
or  piece  of  orris  root.  The  Seton  is  prepared  as  follows  :  A  seton 
needle,  to  which  is  attached  a  skein  of  silk,  is  passed  completely 
through  the  part  chosen  for  the  operation,  after  which  it  ^  is 
removed,  and  the  ends  of  the  silk  left  hanging  from  the  wound. 
It  is  dressed  once,  or  several  times  a  dav,  with  some  mild  oint- 
ment; or,  if  this  is  not  sufficient  to  keep  up  the  discharge,  a  more 
stimulating  ointment  is  used.  Escharotics  are  employed  to  de- 
stroy morbid  growths,  warts,  polypi,  condylomata,  fungous  gran- 
ulations, etc. ;  also  to  relieve  violent  inflammation  by  their  sub- 
stitutive action ;  to   stimulate   indolent   ulcers,  sinuses,   etc. ;  to 


96  DENTAL  MEDICINE. 


open  abscesses  of  the  liver,  and  other  internal  viscera,  the  method 
of  " aspiration  "  being  preferred;  to  remove  cancer,  lupus  and 
other  morbid  growths ;  to  decompose  the  virus  of  rabid  and 
venomous  animals,  and  of  chancres  and  malignant  pustules,  and 
prevent  their  absorption. 

Escharotics  include  such  agents  as  caustic  potassa,  fused  nitrate 
of  silver,  caustic  soda,  solution  of  nitrate  of  mercury,  corrosive 
chloride  of  mercury,  bichromate  of  potassium,  the  mineral  acids, 
sulphate  of  copper,  and  the  substances  before  referred  to. 

DEMULCENTS. 

Demulcents,  also  called  Lenitives^  are  medicinal  substances 
which  soften  and  relax  the  tissues.  When  applied  to  irritated  or 
inflamed  surfaces  these  agents  diminish  the  heat,  tension  and 
pain.  Thev  consist  principally  of  gum  or  mucilage,  often  com- 
bined with  saccharine  or  farinaceous  substances,  and,  diluted  with 
water,  form  viscid  solutions.  By  modifying  the  acridity  of  the 
secretions,  they  are  capable,  to  some  degree  at  least,  of  relieving 
irritation  in  remote  organs,  although  their  constitutional  effects 
are  chiefly  nutritive.  Demulcents  are  employed  internally  to 
protect  the  gastro-enteric  surface  from  irritating  substances, 
especially  poisons  of  an  acrid  nature ;  also  to  relieve  irritation 
and  inflammation  of  the  alimentary  canal  in  such  affections  as 
diarrhoea,  dysentery,  enteritis,  gastritis,  etc. ;  also  in  catarrhal 
affections,  for  their  soothing  and  lubricating  effects  from  direct 
contact,  and  also  by  reflex  action ;  and  they  also  exert  some 
influence  in  modifying  the  acridity  of  expectorated  matters ;  also 
in  such  affections  of  the  urinary  passages  as  cystitis,  ardor  urinae, 
as  they  tend  to  diminish  the  acridity  of  the  secretion  :  also  as 
drinks,  to  promote  the  action  of  the  secreting  and  exhaling  organs, 
and  to  allay  the  thirst  in  fevers  :  also  as  light  diet,  and  to  sus- 
pend substances  insoluble  in  water. 

Demulcents  are  employed  externally  in  the  form  known  as 
Emollients^  to  relieve  the  heat,  swelling  and  pain  of  inflammation, 
wounds  and  burns ;  to  hasten  suppuration,  as  detergents,  to 
cleanse  foul  ulcers,  and  to  promote  suppuration  from  granulating 


REMEDIAL   AGENTS.  97 


surfaces.  Mixed  with  water  in  the  form  of  soft  masses,  they 
are  commonly  termed  cataplasms  or  poultices^  and  have  the  effect 
of  softening  the  parts  to  which  they  are  applied  as  vehicles  of 
heat  and  moisture.  Included  in  the  class  of  demulcents  are  such 
substances  as  gum  arabic,  flax  seed,  tragacanth,  slippery-elm 
bark,  sassafras  pith,  marshmallow,  benne,  quince  seed,  liquorice 
root,  Iceland  moss,  Irish  moss,  starch,  arrow  root,  tapioca,  sago, 
barley,  glycerin,  pyroxylon,  collodion,  solution  of  gutta  percha, 
honey,  animal  fats,  such  as  lard,  in  the  form  of  cerate  (lard  2 
parts,  and  white  wax    i   part),  and  suet,  both  containing  stearine. 

ANTHELMINTICS. 

Anthelmintics,  or  Vermifuges^  are  medicinal  substances  em- 
ployed to  destroy  and  expel  worms  (entozoa)  from  the  alimen- 
tary canal.  Their  action  differs  according  to  the  nature  of  the 
substance  used,  either  to  destroy  by  a  direct  poisonous  influence 
or  by  mechanical  means.  The  most  powerful  of  the  cathartics 
(drastic)  also  acts  as  anthelmintics  by  the  copious  secretion  and 
exhalation  which  they  produce  from  the  alimentary  canal. 
When  anthelmintics  are  employed,  they  must  be  persevered  in 
for  several  days,  with  the  occasional  intervention  of  an  active 
cathartic. 

Belonging  to  this  class  are  such  agents  as  wormseed,  spigelia, 
santonica,  cowhage,  male  fern,  oil  of  turpentine,  kameela,  pump- 
kin seed,  kousso,  calomel  with  gamboge,  calomel  with  pink  root, 
iron  preparations,  etc.,  etc. 

COLORING  AGENTS. 

Coloring  agents  are  substances  employed  to  communicate  their 
peculiar  color  to  pharmaceutical  preparations.  They  include 
saffron,  cochineal,  red  saunders,  etc.,  etc. ;  and  in  dental  practice 
they  are  used  for  coloring  dentrifrices,  such  as  rose  pink. 


In  addition  to  the  general  classes  mentioned,  there  are  certain 

7 


98 


DENTAL  MEDICINE. 


sub-classes  recognized,  which  have  not  been  specially  referred  to 
in  the  preceding  definitions,  as  follows  : — 


Absorbents, 

Anodynes, 

Antemetics, 

Anthridrotics, 

Antiperiodics, 

Antipyretics, 

Antiseptics, 

Aromatic  Bitters, 

Carminatives, 

Caustics, 

Cauterants, 

Constringents, 

Counter-irritants, 

Desiccatives, 


Detergents, 

Deodorizers, 

Diluents, 

Discutients, 

Disinfectants, 

Emollients, 

Errhines, 

Escharotics, 

Expectorants, 

Evacuants, 

Excitants, 

Febrifuges, 

Germicides, 

Hemostatics, 


Hypersthenics, 

Hypnotics, 

Laxatives, 

Nervines, 

Nutritives, 

Purgatives, 

Refrigerants, 

Resolvents, 

Restoratives, 

Sialogogues, 

Stimulants, 

Styptics, 

Vesicants. 


ABSORBENTS. 

Absorbents,  known  also  as  Desiccatives^  are  medicinal  agents 
capable  of  checking  secretions,  and  drying  up  secretions,  or  dis- 
charges from  ulcers  and  suppurating  wounds.  Included  in  this 
class  are  tannic  acid,  oxide  of  zinc,  charcoal,  subnitrate  of  bis- 
muth, starch,  powdered  galls,  magnesia,  powdered  myrrh,  car- 
bonate of  lime,  etc.,  etc. 
> 

ANODYNES    OR  ANALGESICS. 

Anodynes,  which  with  sedatives,  hypnotics,  or  soporifics,  are  in- 
cluded in  the  group  of  narcotics,  are  medicinal  agents  capable  of 
alleviating  pain  by  lessening  the  sensibility  of  the  nerve-centres 
or  the  peripheral  extremities.  When  applied  locally  they  are 
called  analgesics.  Included  in  this  class  are  opium,  morphia, 
chloroform,  sulphuric  ether,  aconite,  croton,  chloral,  belladonna, 
camphor,  gelsemium,  cannabis  indica,  stramonium,  hyoscyamus, 
carbolic  acid,  atropine,  creasote,  cocaine,  eugenol,  iodoform, 
iodol,  antipyrin,  blood-letting,  heat  and  cold,  acupuncture,  etc., 
etc. 

ANTEMETICS. 

Antemetics  are  medicinal  agents  capable  of  arresting  vomiting. 
Included  in  this  class  are  creasote,  dilute  hydrocyanic  acid,  lime 


REMEDIAL   AGENTS.  99 


water,   chloral,    chloroform,   magnesia,   dilute    nitric   acid,  dilute 
phosphoric  acid,  belladonna,  oxalate  of  cerium,  etc. 

ANTHRIDROTICS. 

Anthridrotics  are  medicinal  agents  capable  of  checking  per- 
spiration. Included  in  this  class  are  oxide  of  zinc,  sulphuric 
acid,  acetic  acid,  tannic  acid,  sulphate  of  iron,  hematoxylon,  etc. 

ANTIPERIODICS. 

Antiperiodics  are  medicinal  agents  capable  of  relieving  period- 
ical diseases,  such  as  intermittent  fevers,  neuralgia,  etc.  Included 
in  this  class  are  cinchona,  quinia,  arsenic  (in  form  of  Fowler's 
solution),  chloroform,  chloride  of  soda,  salicin,  etc. 

ANTIPYRETICS. 

Antipyretics  are  medicinal  agents  having  a  decided  power  to 
depress  the  temperature  of  the  body  during  fever,  and  control 
hyperpyrexia.  Included  in  this  class  are  antifebrin,  antipyrin, 
quinoline  or  chinoline,  thalline,  kairine,  camphor,  eucalyptol, 
hydroquinon,  pyrodin,  resorcin,  quinine,  salicine,  thymol,  salol, 
etc, 

ANTISEPTICS. 

Antiseptics  are  medicinal  agents  capable  of  arresting  fermenta- 
tive processes,  preventing  the  development  of  bacteria,  thereby 
preventing  or  arresting  the  decomposition  of  organic  substances, 
and  the  process  of  putrefaction.  When  these  agents  are  brought 
in  contact  with  disease  germs  they  destroy  their  vitality.  In- 
cluded in  this  class  are  carbolic  acid,  creasote,  salicylic  acid, 
eucalyptus  oil,  iodoform,  benzoic  acid,  boracic  acid,  pepsin, 
bromine,  iodol,  hydronapthol,  peroxide  of  hydrogen,  pyrozone, 
aristol,  bichloride  of  mercury,  essential  oils,  etc. 

Forms  of  Antiseptics  for  Use :  Dr.  Black  on  this  subject  says: 
*'  In  regard  to  the  use  of  antiseptics  in  different  cases  and  for 
different  purposes,  I  should  divide  them  into  three  forms,  each  of 
which  has  especial  advantages. 

"  These  forms  are :  the  solution  in  water,  the  oil,  and  the 
powder. 


100  DENTAL  MEDICINE. 


"  The  solution  in  water  is  especially  useful  for  cleaning  in- 
fected surfaces  of  wounds,  washing  abscesses,  and,  indeed,  in 
any  case  where  there  is  something  that  can  be  removed  by  wash- 
ing. In  the  performance  of  this  act  the  antiseptic  is  diffused  to 
all  parts  of  the  wound  or  abscess  mechanically  to  the  best  ad- 
vantage. It  is  more  likely  to  reach  every  part  in  this  form  than 
in  any  other;  and  this  is  an  advantage  that  can  hardly  be  over- 
estimated ;  for  it  is  very  difficult  to  reach  all  parts  of  an  abscess 
by  any  mode  of  procedure  now  known  to  us  on  account  of  the 
very  tardy  diffusion  of  liquids.  And  in  case  the  liquid  contain- 
ing the  antiseptic  in  solution  does  diffuse,  its  very  diffusion  and 
mixture  with  the  surrounding  fluids  soon  dilutes  it  below  its 
range  of  antiseptic  value.  It  is  therefore  necessary  that  the 
washing  be  continuous  to  obtain  the  continuous  effect  of  the 
drug.  This  is  generally  impracticable,  and  for  this  reason  the 
watery  form  of  antiseptics  is  very  much  limited  in  usefulness. 
The  continuous  drip,  or  the  application  as  often  as  every  fifteen 
or  twenty  minutes,  gives  effective  results  in  some  favored  locali- 
ties ;  but  it  is  very  difficult  to  carry  out  and  occasions  much 
trouble.  The  continuous  bath  is  still  more  limited  in  its  range 
of  application.  Neither  of  these  can  be  used  in  dental  practice. 
With  us  the  watery  form  of  antiseptics  should  be  limited  to  the 
cleaning  of  infected  parts.  They  cannot  be  trusted  to  prevent 
septic  action  for  any  length  of  time,  for  the  reason  that  they  so 
soon  become  diluted  below  their  range  of  antiseptic  value  by 
mixing  with  the  secretions,  or  the  juices  of  the  flesh.  Since 
studying  the  powers  of  antiseptics  and  disinfectants  more  closely, 
my  feeling  is  that  it  will  not  do  for  us  to  expect  to  do  too  much 
disinfectant  work  in  connection  with  the  soft  tissues  except  in 
cases  in  which  some  tissue  destruction  can  be  borne  ;  and  that 
antiseptics  only  retard  the  growth  of  microbes  during  their  pres- 
ence in  effective  proportion  ;  hence  the  necessity  for  continuous 
and  oft  repeated  application.  In  using  these  for  the  purpose  of 
cleaning,  much  aid  may  be  had  by  making  use  of  the  solution  in 
peroxide  of  hydrogen  instead  of  water,  so  as  to  obtain  the 
mechanical  effect  of  the  ebullition  of  the  oxygen  evolved  in  mix- 
ing the   antiseptic  with   the  secretions.     There   is  possibly  some 


REMEDIAL  AGENTS.  101 


antiseptic  virtue  in  oxygen  itself  as  well;  but  I  am  apt  to  think 
that  its  principal  use  is  the  mechanical  one.  And  that  is  a  very 
important  use.  Thorough  cleaning  is  excellent  antiseptic  work, 
and  the  peroxide  of  hydrogen  will  do  this  in  many  positions 
where  nothing  else  will,  and  at  the  same  time  carry  the  antiseptic 
proper  to  the  more  remote  parts  of  the  wound  or  abscess." 

Sir  Joseph  Lister  is  the  originator  of  the  antiseptic  treatment  in 
surgery.  He  first  employed  carbolic  acid  as  an  antiseptic  for 
surgical  dressings,  but  abandoned  it  on  account  of  its  slow  ac- 
tion as  a  germicide  and  its  volatility.  He  then  employed  bichlo- 
ride of  mercury,  which  was  stable  and  acted  promptly,  but  caused 
irritation,  and  was  precipitated  by  the  albumen  contained  in  the 
serum  of  the  blood.  He  then  employed  the  sero-sublimate  gauze, 
consisting  of  gauze  saturated  with  a  solution  of  bichloride  of  mer- 
cury, in  the  serum  of  the  blood  ;  but  this  being  harsh  and  non-ab- 
sorbent he  substituted  for  it  a  combination  of  chloride  of  ammonia 
and  chloride  of  mercury,  known  as  sal-alembroth,  which  was  not 
only  less  irritating,  but  was  soluble  in  blood  serum.  Later  he  pre- 
sented the  double  cyanide  of  zinc  and  mercury  as  the  best  antiseptic, 
on  account  of  its  being  non-volatile,  unirritating,  insoluble  in  water, 
and  only  soluble  in  3,000  parts  of  blood  serum,  with  an  inhibitory 
power  so  high  that  a  solution  of  1:1200  is  sufficient  to  keep  animal 
fluids  permanently  free  from  putrefaction.  The  Listerian  method 
consists  in  applying  over  the  line  of  the  wound  six  or  eight  layers 
of  the  gauze,  out  of  which  the  bichloride  has  been  washed  by 
wringing  it  out  once  or  twice  in  a  solution  of  i  to  20  carbolic 
acid.  All  zymotic  diseases  are  at  the  present  time  generally 
attributed  to  bacteria  or  to  their  ptomaines,  and  for  a  number  of 
years  the  theory  that  all  contagious  and  epidemic  diseases  are 
caused  by  micro-organisms  has  been  received  by  the  medical  pro- 
fession. Many  diseases  are  now  regarded  as  contagious  which 
were  not  so  considered  before  the  discovery  of  bacteria.  Bacteria 
are  found  in  great  numbers  and  different  varieties  in  the  air,  earth, 
water,  and  in  every  part  of  the  body  of  man  and  animals,  and 
multiply  very  rapidly  by  division  and  by  spores.  Some  va- 
rieties are  subject  to  change,  others  appear  to  be  permanent. 
New   varieties  are  supposed  to  be  produced  by  the  same  laws  by 


102  DENTAL  MEDICINE. 


which  the  different  kinds  of  vegetables,  plants  and  animals  are 
generated.  The  discoveries  in  bacteriology  have  brought  about  a 
revolution  in  the  treatment  of  many  diseases,  namely,  tuberculosis 
— as  the  Koch  treatment — typhoid  and  other  fevers,  carbuncle, 
erysipelas,  diptheria,  pneumonia,  influenza,  malaria,  tetanus,  etc., 
etc.      (See   Use  of  Antiseptics  in  Dental  Practice.^ 

AROMATIC    BITTERS. 

Aromatic  bitters  differ  from  simple  bitters  in  the  aromatic 
constituents  they  contain.  They  possess  tonic  properties  and 
invigorate  digestion  and  promote  constructive  metamorphosis. 
They  are  employed  in  the  same  cases  as  simple  bitters,  but  ap- 
pear to  possess  some  specific  properties  due  to  the  aromatic  con- 
stituents. Included  in  this  class  are  sepentaria,  prunus  virginiana, 
canella,  anthemis,  etc. 

CARMINATIVES. 

Carminatives  are  medicinal  agents  capable  of  dispelling  flatu- 
lence, and  allaying  pain  in  the  stomach  and  bowels.  Included  in 
this  class  are  such  agents  as  cinnamon,  cardamom,  cloves,  corian- 
der, lavender,  juniper,  ginger,  caraway,  peppermint,  etc. 

CAUSTICS. 

Caustics  are  medicinal  substances  capable  of  destroying  vitalized 
tissue.     (See  Irritants.) 

CAUTERANTS  (See  Irritants). 

CONSTRINGENTS  (See  Astringents). 

COUNTER-IRRITANTS. 

Counter-irritants  are  medical  agents  which  are  employed  to 
produce  external  irritation  for  the  purpose  of  relieving  or  curing 
diseased  action  in  another  part,  as  in  periodontitis,  for  example, 
when  such  agents  as  iodine,  cantharidical  collodion,  creasote  and 
iodine,  aconite  and  iodine,  ammonia,  etc.,  etc.,  are  applied  to  the 
gum  over  the  root  of  the  affected  tooth.     (See  Irritants.) 

DESICCATIVES. 

Desiccatives  are  medicinal  agents  capable  of  checking  secre- 
tions and  arresting  mucous  discharges  from  ulcers,  wounds,  etc. 
(See  Absorbents.) 


REMEDIAL  AGENTS.  103 


DETERGENTS. 

Detergents  are  medicinal  agents  capable  of  cleansing  ulcers, 
suppurating  wounds,  etc.,  by  acting  as  either  stimulants  or 
emollients.  Included  in  this  class  are  such  agents  as  borax, 
burnt  alum,  sllppery-elm  bark,  acacia,  flaxseed,  tragacanth,  etc. 

DEODORIZERS. 

Deodorizers  are  medicinal  agents  capable  of  destroying  infections 
and  fetid  odors.  Included  in  this  class  are  carbolic  acid,  sali- 
cylic acid,  creasote,  chloride  of  lime,  charcoal,  permanganate  of 
potash,  thymol,  chloride  of  zinc,  solution  of  chloride  of  soda,  oil 
of  eucalyptus,  iodoform,  menthol,  hydrochloric  acid,  nitric  acid, 
sulphuric  acid,  etc.,  etc.      (See  Jntiseptics.) 

DILUENTS. 

Diluents  are  medicinal  agents  capable  of  diluting  the  blood  and 
thus  increasing  its  fluidity  ;  at  the  same  time  exercising  a  solvent 
action  and  eliminating  a  portion  of  the  solid  constituents.  In^ 
eluded  in  this  class  are  such  agents  as  water,  aerated  water,  min- 
eral waters,  rice  water,  beef  tea,  whey,  barley  water,  gruel,  etc.,  etc. 

DISCUTIENTS. 

Discutients  are  medicinal  agents  capable  of  reducing  and  de- 
pressing morbid  growths,  swellings,  etc.  Included  in  this  class 
are  iodine,  mercury,  bromide  of  potassium,  iodide  of  potassium, 
chlorate  of  potassium,  arsenic,  colchicum,  etc.,  etc. 

DISINFECTANTS. 

Disinfectants  are  medicinal  agents  capable  of  depriving  effluvia 
of  their  morbific  properties  by  chemically  combining  with  them. 
Included  in  this  class  are  such  agents  as  chlorine,  carbolic  acid, 
carbolate  of  lime,  chloride  of  lime,  salicylic  acid,  solution  of  chlori- 
nated soda,  charcoal,  creasote,  hydrochloric  acid,  sulphuric  acid, 
nitric  acid  and  chloride  of  zinc.     (See  Antiseptics  and  Deodorizers.) 

EMOLLIENTS. 

Emollients,  or  Protectives^  are  medicinal  agents  capable  of  re- 
laxing soft  tissues,  allaying  irritation,  protecting  sensitive  surfaces, 


104  DENTAL  MEDICINE. 

relieving  pain  in  ulceration  of  mucous  membrane.  Included  in 
this  class  are  glycerin,  collodion,  solution  of  gutta  percha,  acacia, 
tragacanth,  Irish  moss,  sassafras  pith,  flaxseed,  slippery-elm  bark, 
liquorice  root,  wax,  in  the  form  of  cerate  ointment,  poultices  of 
bread  and  milk,  yeast  and  flaxseed,  and  charcoal  and  yeast  with 
flaxseed,  lard,  etc.,  etc. 

ERRHINES. 

Errhines  are  medicinal  agents  capable  of  inducing  a  secretion 
from  the  nose.  Included  in  this  class  are  ammonia,  ipecacuanha, 
chlorine,  acetic  acid,  orris  root,  etc.,  etc. 

ESCHAROTICS. 

Escharotics  are  medicinal  agents  capable' of  producing  an  eschar 
or  slough,  and  are  included  among  Irritants.     (See  Irritants.) 

EXPECTORANTS. 

Expectorants  are  medicinal  agents  capable  of  promoting  the 
excretion  of  mucus  and  other  fluids  from  the  air  passages  and 
lungs.  Included  in  this  class  are  squill,  ipecacuanha,  benzoic 
acid,  preparations  of  ammonia,  tartar  emetic,  balsam  of  tolu,  myrrh, 
nitrate  of  potash,  seneca,  wild  cherry  bark,  lobelia,  etc.,  etc. 
(See  Blennorrhet'tcs?) 

EVACUANTS. 

Evacuants  belong  to  the  class  of  cathartics  which  promote 
alvine  evacuations.     (See  Cathartics^ 

EXCITANTS. 

Excitants  belong  to  the  class  of  stimulants  which  excite  the 
vital  powers,  causing  an  increase  of  the  circulation.  (See  Stimu- 
lants.) 

FEBRIFUGES    OR    ANTIPYRETICS. 

Febrifuges  are  medicinal  agents  capable  of  diminishing  the 
heat  and  allaying  the  thirst  of  fevers,  and  are  generally  recognized 
as  Refrigerants.  Included  in  this  class  are  nitrate  of  potassa, 
chlorate  of  potassa,  the  mineral  acids,  spirits  of  nitrous  ether, 
antipyrin,  chinoline,  salicin,  etc.,  etc. 


REMEDIAL  AGENTS.  lo5 


GERMICIDES. 

Germicides  include  all  substances  which  destroy  any  form  of 
microbe  or  disease  germs,  such  as  bacteria,  which  are  inimical  to 
life.  Included  in  this  class  are  bichloride  of  mercury,  peroxide 
of  hydrogen,  iodoform,  iodol,  iodine,  salicylic  acid,  eucalyptus, 
carbolic  acid,  chlorine,  chloride  of  zinc,  permanganate  of  potash, 
naphthol,  etc. ;  also  heat.  All  germicides  are  antiseptics,  but  all 
antiseptics  are  not  germicides. 

HEMOSTATICS. 

Hemostatics  are  medicinal  agents  capable  of  arresting  hemor- 
rhage, and  belong  to  the  class  of  Astringents.  (See  Astringents 
and  Styptics.) 

HYPERSTHENICS. 

Hypersthenics  belong  to  the  class  of  stimulants.  (See  Stimu- 
lants.) 

HYPNOTICS. 

Hypnotics  belong  to  the  class  of  Narcotics,  and  are  capable 
of  causing  sleep.     (See  Narcotics.) 

LAXATIVES. 

Laxatives  are  mild  cathartics.     (See  Cathartics.) 

NERVINES. 

Nervines  belong  to  the  class  of  Neurotics,  and  are  capable  of 
relieving  and  curing  disorders  of  the  nerves.     (See  Neurotics.) 

NUTRITIVES. 

Nutritives  are  medicinal  agents  capable  of  quickening  assimi- 
lation and  building  up  the  organic  tissues.  Included  in  this  class 
are  cod-liver  oil,  gum  arable,  glycerin,  milk,  manna,  etc.,  etc. 
Beef  extracts  are  stimulants  rather  than  nutritives  for  building 
up  organic  tissues. 

PURGATIVES. 

Purgatives  are  active  cathartics,  and  are  divided  into  several 
classes,  according  to  the  nature  of  their  action,  such  as  :  Laxa- 
tives, which  incite  intestinal  movements  without  much  increase 
of  the   intestinal   secretions.     Included   in   this  class  are  manna. 


106  DENTAL  MEDICINE. 


sulphur,  magnesia,  castor  oil,  etc.  Saline  Purgatives^  which  pro- 
duce increased  secretion,  and  at  the  same  time  hasten  the  peri- 
staltic action,  the  stools  being  loose  and  watery.  Included  in  this 
class  are  sulphate  of  magnesia,  phosphate  of  soda,  tartrate  of 
potassium  and  sodium,  Seidlitz  powder,  bitartrate  of  potassium,  etc. 
Mercurial  Purgatives^  principally  calomel  and  blue  mass,  which 
are  supposed  to  produce  cholagogue  effects,  and  also  an  influence 
peculiar  to  themselves.  Tonic-astringent  and  resin-bearing  purga- 
tives^ which  have  an  influence  over  the  liver  and  the  glandular 
appendages,  and  promote  the  tonicity  of  the  muscular  layer  of 
the  intestines.  Included  in  this  class  are  senna,  rhubarb,  aloes, 
jalap,  scammony,  colocynth,  podophyllum,  etc.  Hydragogue  pur- 
gatives^ which  are  very  energetic  in  their  action,  increase  the 
glandular  secretions  and  cause  an  abundant  outward  diffusion  to 
such  a  degree  as  to  produce  very  watery  stools ;  and  also  excite 
rapid  and  severe  peristaltic  movements.  Included  in  this  class 
are  gambogia,  croton-oil,  elaterium,  etc.     (See  Cathartics.) 

REFRIGERANTS. 

Refrigerants  are  medicinal  agents  which  are  capable  of  dimin- 
ishing heat  and  allaying  thirst.  .  They  are  also  called  Febrifuges. 
Included  in  this  class  are  nitrate  of  potassa,  chlorate  of  potassa, 
solution  of  acetate  of  ammonia,  acetic  acid,  citric  acid,  hydro- 
chloric acid,  nitric  acid,  tartaric  acid,  spirits  nitrous  ether,  etc., 
etc. 

RESOLVENTS. 

Resolvents  belong  to  the  class  of  Alteratives  and  Emollients, 
being  medicinal  agents  capable  of  reducing  inflammation  and  dis- 
persing morbid  swellings.     (See  Alteratives  and  Emollients.) 

RESTORATIVES. 

Restoratives  belong  to  the  class  of  Stimulants  and  Tonics. 
(See  Stimulants  and  Tonics.) 

SIALAGOGUES. 

Sialagogues  are  medicinal  substances  capable  of  increasing  the 
salivary  secretion  by  a  stimulant  or  irritant  effect.  By  the  ex- 
citant  properties   of  these    agents   the    lining    membrane   of  the 


REMEDIAL  AGENTS.  IQ' 


mouth  is  irritated,  the  effect  extending  along  the  ducts  to  the 
salivary  glands,  so  that  not  only  is  the  quantity  of  fluid  exhaled 
from  the  mucous  membrane  increased,  but  salivation  results.  In 
this  way  depletion  follows  their  employment,  and  more  or  less 
revulsive  effect  ensues,  which  may  prove  beneficial  to  distant 
parts  affected  by  disease.  Sialagogues  may  also  prove  useful  in 
cases  of  paralysis  of  the  tongue,  etc.,  by  their  directly  excitant 
properties ;  also  in  local  palsy  of  the  tongue.  Thev  are  occa- 
sionally employed  as  masticatories  in  odontalgia,  and  in  such  af- 
fections of  the  head  as  may  indicate  the  use  of  substances  which 
excite  irritation  in  and  increased  discharge  from  the  lining  mem- 
brane of  the  nasal  cavities.  Included  in  this  class  are  pyrethrum, 
horse  radish,  calamus,  ginger,  tobacco,  calomel,  corrosive  subli- 
mate, blue  mass,  iodide  of  mercury,  etc. 

STYPTICS. 

Styptics  which  belong  to  the  class  of  Jstringents  are  medicinal 
agents  capable  of  arresting  hemorrhage  when  employed  exter- 
nally. They  are  divided,  according  to  their  action,  into  chemical 
and  mechanical^  the  chemical  styptics  coagulating  the  blood  ex- 
uding from  the  part,  and  at  the  same  time  stimulating  the  tissues 
to  contraction  ;  whilst  the  mechanical,  as  lint,  felt,  spider's  web, 
plaster  of  Paris,  etc.,  detain  the  blood  in  their  meshes,  or  absorb 
it  until  it  coagulates,  and  thus  arrest  the  hemorrhage.  Among 
the  Astringents  which  may  be  classed  as  Styptics  and  local  astrin- 
gents are  tannic  acid,  persulphate  of  iron  solution,  powdered 
subsulphate  of  iron,  alum,  nitrate  of  silver,  powdered  galls,  sul- 
phuric acid,  matico,  gallic  acid,  perchloride  of  iron,  catechu,  oak- 
bark  rhatany,  etc. ;  and  as  mechanical  styptics,  collodion,  matico, 
spider's  web. 

By  contraction  of  the  blood  vessels  internally  :  digitalis  and 
ergot ;  also  for  checking  excessive  discharges :  acetate  of  lead, 
carbonate  of  lead,  subacetate  of  lead,  lime  water,  the  application 
of  cold  as  ice,  and  of  heat,  as  hot  water,  etc. 

VESICANTS. 

Vesicants,  which  belong  to  the  class  of  Epispastics^  are  medic- 
inal agents  capable  of  producing  a  serous  exudation  beneath  the 


108  DENTAL  MEDICINE. 


cuticle.  Included  in  this  class  are  cantharides,  cantharidal  col- 
lodion, glacial  acetic  acid,  strong  solution  of  ammonia,  mustard, 
etc,  etc.     (See  Epispastics.) 

FORMS  IN  WHICH  MEDICINAL  SUBSTANCES  ARE  EMPLOYED. 

Alkaloids  are  bases  capable  of  combining  with  acids  to  form 
salts,  and  which  exist  as  proximate  principles  in  certain  vegeta- 
bles, and  possess  the  properties  of  an  alkali  in  a  greater  or  less 
degree.  Alkaloids  are,  therefore,  the  active  principles  of  medi- 
cines. 

Baths. — Medicinal  Baths  are  composed  of  tepid  water,  with 
the  addition  of  saline,  emollient,  narcotic  or  stimulant  substances, 
such  as  salt,  mustard,  etc.,  etc. 

Capsules  are  short  tubes  made  of  glycerin,  and  are  agreeable 
forms  for  administering  medicines  which  are  unpleasant  to  the 
taste. 

Cataplasms  are  poultices  or  plasters  composed  of  soft,  macer- 
ated preparations,  to  be  applied  externally. 

CoLLYRiA  are  preparations  applied  to  the  eyes.  They  are 
sometimes  dry,  but  generally  liquid,  consisting  of  infusions,  decoc- 
tions or  distilled  waters,  with  the  addition  of  various  medicinal 
substances. 

Confections,  or  Electuaries^  are  preparations  made  into  a  pulpy 
mass,  with  sugar  or  honey,  mucilage  or  glycerin. 

Decoctions  are  solutions  made  by  boiling  certain  vegetable  in- 
gredients in  a  fluid,  for  the  purpose  of  extracting  the  parts  solu- 
ble at  that  temperature. 

Dentifrices  are  antiseptic  and  alkaline  mixtures,  in  the  form 
of  powders  and  pastes,  for  cleaning  the  teeth. 

Emulsions  are  preparations  composed  of  oils,  resins,  etc.,  sus- 
pended by  means  of  mucilage,  yolk  of  egg,  sugar,  etc. 

Enemata,  or  Clysters^  are  liquid  preparations  injected  into  the 
rectum  by  means  of  a  syringe,  as  auxiliaries  to  or  substitutes  for 
cathartics. 

Extracts  are  preparations  obtained  by  the  evaporation  of  a 
vegetable  solution,  in  the  form  of  juices,  infusions  or  decoctions, 
to  a  more  or  less  fluid  consistence. 


THERAPEUTIC   FORMS,  109 


Fomentations  are  fluid  preparations  applied  to  the  surface  of 
the  body  by  means  of  a  sponge,  flannel  or  soft  cloth. 

Fumigations  are  the  vapors  of  medicinal  substances  employed 
to  purify  infected  air  by  absorbing  or  otherwise  counteracting 
deleterious  gases.  They  are  also  employed  in  diseases  of  the  skin, 
and  may  be  sometimes  substituted  for  a  local  bath. 

Gargles  are  washes  for  the  mouth  and  throat,  and  are  gener- 
allv  astringent  and  stimulating,  sedative,  refrigerant,  etc.  To  be 
of  any  service,  gargles  or  mouth  washes  must  be  frequently 
applied  and  persevered  in  for  some  time.  They  are  employed  in 
cases  of  inflammation  and  ulceration  of  the  mucous  membrane 
of  the  mouth  and  fauces. 

Glycerites  are  combinations  of  medicinal  substances  with 
glycerin. 

Glycerols  are  combinations  made  by  dissolving  medicinal 
agents  in  glycerin. 

Infusions  are  preparations  obtained  by  pouring  a  hot  or  cold 
fluid  upon  vegetable  substances,  for  the  purpose  of  extracting 
their  medicinal  properties. 

Inhalants  are  remedies  in  the  form  of  steam,  for  inhalation 
directly  to  the  lungs. 

Injections  are  medicated  fluids  thrown  into  a  natural  or  pre- 
ternatural cavity  of  the  body  by  means  of  a  syringe. 

Liniments,  or  Embrocations,  are  unctuous  medicinal  prepara- 
tions to  be  applied  externally  by  means  of  friction. 

Lotions  are  liquid  preparations  or  washes,  to  be  applied  to  the 
body  externally. 

Mouth-Washes  are  liquid  preparations,  antiseptic  in  charac- 
ter, and  also  containing  either  astringents,  sedatives  or  refrigerants, 
according  to  the  condition  of  the  mouth  to  be  corrected. 

Mixtures  are  fluid  preparations  containing  several  medicinal 
ingredients,  to  be  administered  by  the  mouth. 

Mucilages  are  solutions  of  colloid  substances,  such  as  acacia, 
in  water. 

Ointments,  or  Cerates,  are  preparations  of  the  consistence 
of  lard,  composed  of  wax,  lard,  or  resin,  with  solid  or  liquid 
ingredients,    for    topical     application.      Cerates    are     somewhar 


110  DENTAL  MEDICINE. 


harder  than  ointments,  especially  where  wax  is  substituted  for  the 
lard. 

Oleates  are  medicinal  ointments.     (See  Medicinal  Oleates.) 

Pills  are  simple  or  compound  medicinal  agents,  of  a  firm  con- 
sistence, spherical  or  globular  in  shape,  and  generally  not  exceed- 
ing five  or  six  grains  in  weight. 

Plasters  are  preparations  of  a  solid  glutinous  composition, 
which,  at  the  ordinary  temperature  of  the  body,  adheres  to  the 
part  on  which  it  is  placed. 

Powders  are  dry  substances  in  minute  subdivision. 

Poultices  are  preparations  for  applying  continuous  heat  and 
moisture  and  softening  the  tissues.  Their  effects  are  to  cause 
an  afflux  of  blood  to  the  part,  dilate  the  vessels  and  soften  the 
tissues  by  the  influence  of  both  heat  and  moisture,  and  render  the 
diffusion  of  the  fluids  easy.  In  inflammatory  conditions,  the 
stasis  of  the  vessels  implicated  is  relieved,  the  tension  of  the  parts 
lessened  and  resolution  brought  about.  Where  the  stage  of  ex- 
udation is  present,  these  preparations  promote  the  increase  and 
migration  of  the  white  corpuscle  and  facilitate  the  escape  of 
purulent  matter.  Poultices  also  relieve  the  pain  of  inflamed 
parts  by  relaxing  the  tissues,  and  thereby  removing  pressure 
from  the  sensory  nerve  filaments ;  they  relieve  pain  in  parts 
distant  from  the  points  where  their  applications  are  made,  and 
have  both  a  local  and  systemic  effect.  Poultices  are  generally 
composed  of  such  substances  as  flaxseed  meal,  powdered  slippery- 
elm  bark  and  corn  meal ;  also  bread  and  milk  are  sometimes 
employed. 

The  substance  dissolved  in  hot  water  is  spread  upon  soft  mus- 
lin of  such  a  size  as  to  allow  one  free  end  to  fold  over  the  mass 
and  intervene  between  it  and  the  surface  of  the  skin ;  or  it  may 
be  inclosed  in  a  small  bag  of  muslin.  Glycerin  spread  over  the 
surface  of  a  poultice  will  prevent  its  drying.  Laudanum  is 
often  added  to  mitigate  the  pain,  if  necessary;  also  charcoal  in 
the  form  of  powder.  A  yeast  poultice  is  made  of  brewer's  yeast 
with  enough  of  flaxseed  to  give  it  a  proper  consistence.  Poultices 
should  not  be  allowed  to  remain  too  long,  as  their  effect  will 
cause  the  skin  to  become  white,  wrinkled  and  pulpy,  and  lead  to 


INFLAMMATION.  m 


the  formation  of  small  boils  or  abscesses ;  also,  in  case  of 
wounded  or  ulcerated  surfaces,  their  too  long  use  will  cause  the 
granulations  to  become  pale  and  flabby  and  prevent  healing ; 
besides,  if  the  granulations  are  large,  they  lower  the  tone  and 
vigor  of  the  system,  depress  the  circulation,  and  exhaust  the  irri- 
tability of  the  vaso-motor  nerves,  and  thus  prevent  healing. 
Poultices  are  employed  in  boils,  carbuncles,  irritable  ulcers,  gan- 
grenous sloughs.  The  charcoal  and  yeast  poultices  are  used  in 
foul  wounds.  Poultices  are  also  applied  with  benefit  in  pneu- 
monia, pleuritis,  pericarditis,  hepatitis,  peritonitis,  faucial  in- 
flammation, etc. 

Spirits  are  solutions  of  colorless  substances,  or  oils  in  rectified 
spirit. 

Stearoptenes  are  the  solid  constituents  of  volatile  oils. 

Suppositories  are  solid  preparations,  of  a  round,  cylindrical  or 
conical  form,  to  be  introduced  into  the  anus ;  and  are  composed 
of  sedative,  astringent,  or  purgative  medicines,  combined  with 
suet,  cocoa-butter,  honey  or  soap. 

Syrups  are  liquid  conserves,  made  by  dissolving  sugar  with 
some  plant,  or  in  water,  either  with  or  without  medicinal 
impregnation. 

Tablets  are  small  flat  preparations  made  from  drugs  and  sugar 
of  milk,  which  have  been  minutely  subdivided,  admixed,  and 
compressed. 

Tinctures  are  preparations  in  the  form  of  solutions  of  the 
active  portions  of  medicinal  substances,  in  rectified  or  proof 
spirits.  A  tincture  is  called  simple  when  it  holds  only  one  sub- 
stance in  solution,  and  compound^  when  two  or  more  ingredients 
are  submitted  to  the  solvent. 

INFLAMMATION: 
WITH    SPECIAL    reference    TO    ORAL    MUCOUS    MEMBRANE. 

Definition  of  Conditions  Associated  with  Disturbances  of  Nutri- 
tion.— Hyperemia  signifies  superabundance  of  blood  in  the  blood 
vessels,  but  this  term  is  restricted  to  such  a  condition  existing  in 
a  definite  organ   or  portion   of  an  organ  ;  hence  hyperemia  and 


112  DENTAL  MEDICINE. 


dilatation  of  blood  vessels  are  so  intimately  connected  that  the 
one  cannot  exist  without  the  other. 

It  is  also  necessary  that  the  capillaries  as  well  as  the  arteries 
and  veins  should  be  injected,  in  order  that  the  color  of  the  region 
so  affected  should  be  increased,  as  the  former  constitute  a  dense 
network,  which  traverses  the  entire  organ,  while  the  latter  only 
form  single  branches  which  occupy  limited  spaces.  There  are 
two  forms  of  hyperemia,  active  and  passive;  in  the  active  form 
there  is  an  increased  quantity  of  arterial  blood  passing  into  the 
part,  while  in  the  passive  form  a  partial  or  complete  stagnation 
of  the  blood  through  the  vessels  occurs. 

The  term  Plethora^  as  distinguished  from  hyperemia,  signifies 
a  superabundance  of  blood  in  the  entire  circulatory  system— an 
increased  amount  of  blood  in  all  the  vessels  of  the  body.  Active 
hyperemia  in  the  skin  and  mucous  membranes  is  characterized 
by  a  diffuse  bright-red  coloration,  the  parts  so  affected  having  a 
higher  temperature  than  those  around  them.  The  diffuse  color- 
ation is  caused  by  the  bright-red  arterial  blood  which  fills  the 
capillaries ;  and  the  elevation  of  the  temperature  is  due  to  the 
presence  of  the  blood,  which  heats  the  skin  or  mucous  mem- 
branes, and  the  more  quickly  the  blood  circulates  the  warmer 
the  tissues  become,  until  at  length  the  highest  degree  of  blood 
heat  is  accomplished. 

Passive  hyperemia  denotes  a  condition  of  the  tissues  character- 
ized by  a  diffuse  venous,  not  arterial,  coloration  and  a  relatively 
low  temperature.  In  passive  hyperemia  the  capillaries  are  also 
dilated,  but  the  blood-current  through  them  is  retarded  ;  hence 
the  tissues  so  affected  are  of  a  venous  color  instead  of  the  bright- 
red  or  arterial  color  of  active  hyperemia. 

The  term  Anemia  signifies  a  condition  in  which  there  is  an 
abnormal  diminution  in  the  amount  of  blood,  and  is  the  opposite 
to  that  of  Plethora,  being  characterized  by  a  pale  face,  lips,  gums 
and  mucous  membranes.  But  the  normal  amount  of  blood  may 
be  present,  and  yet  the  characteristic  paleness  denote  an  anemic 
condition,  for  the  reason  that  the  number  of  red  blood  corpuscles 
are  decreased  and  replaced  by  white  blood  corpuscles,  or  by 
blood  plasma. 


INFLAMMATION.  113 


Again,  the  paleness  of  an  anemic  condition  may  be  due  to  a 
deficiency  of  the  red  coloring  matter  of  the  red  blood  corpuscles. 
A  permanent  contraction  of  the  blood  vessels  may  also  cause  a 
paleness  of  the  face,  lips,  gums  and  mucous  membranes. 

The  term  Ischemia  is  also  employed  to  denote  local  poverty  of 
the  blood,  a  deficiency  of  the  coloring  matter  (hemoglobin). 

The  direct  cause  of  hyperemia,  and  also  of  ischemia,  is  a 
change  of  calibre  of  the  blood  vessels,  namely,  dilatation  and 
contraction.  This  dilatation  and  contraction  of  the  blood  ves- 
sels are  due  to  the  elastic  and  contractile  elements  of  the  sheaths 
and  walls  of  the  arteries  and  veins,  and  both  the  dilatation  and 
contraction  are  regulated  by  the  spinal  cord,  through  the  medium 
of  the  vaso-motor  nerves.  It  is  a  common  opinion  that  hyper- 
emia cannot  exist  without  the  influence  of  the  vaso-motor  nerves. 

Irritation  indicates  the  condition  of  a  tissue  in  which  there 
exists  an  excess  of  vital  action,  on  account  of  the  disordered 
state  of  the  nerves  of  the  affected  part  or  organ.  It  is  commonly 
manifested  by  such  symptoms  as  increased  circulation,  warmth 
and  sensibility,  and  functional  disturbance  of  a  greater  or  less 
degree. 

What  inflammation  is  to  the  vascular  system,  irritation  is  to 
the  nervous  system,  and  the  difference  between  these  two  con- 
ditions is  defined  bv  the  explanation  that  the  latter  terminates 
when  the  former  begins.  Irritation  is  generally  excited  by  the 
action  of  certain  stimuli  upon  organic  tissues,  by  which  the 
sensibility  of  such  tissues  is  perverted  and  the  circulation  de- 
ranged; such  pathological  conditions  when  they  are  not  the  pre- 
cursor of  inflammation,  soon  passing  off",  and  the  affected  tissue 
regaining  its  normal  state  when  the  exciting  cause  ceases  to 
operate.  Irritation  may  be  direct  and  indirect — direct  when  the 
irritation  manifests  itself  at  the  point  where  the  impression  to 
which  it  owes  its  origin  is  received  ;  indirect  when  the  irritation, 
through  sympathy  and  reflex  action,  is  transmitted  to  more  or 
less  remote  parts  or  organs.  An  example  of  direct  irritation  mav 
be  adduced  bv  friction  upon  the  skin  or  mucous  membrane  of 
the  mouth  sufficient  to  cause  redness  in  the  first  tissue,  and  in- 
creased coloration   in   the  second  ;  or  indirect  irritation,   in  the 


114  DENTAL  MEDICINE. 


convulsions  attending  difficult  dentition,  the  irritation  being  com- 
municated to  the  brain  by  the  fifth  pair  of  nerves,  and  from 
thence  to  the  nerves  of  the  voluntary  muscles,  the  seat  of  the 
spasmodic  action.  Dental  caries  also  affords  another  example  of 
indirect  irritation,  in  the  form  of  neuralgic  pains  of  the  temple, 
face,  ear,  eye,  and  of  even  more  remote  parts,  such  as  the  uterus. 

The  effect  of  irritation  upon  the  vascular  system  is  manifested 
by  dilatation  of  the  blood  vessels;  but  the  immediate  effect,  how- 
ever, of  a  slight  chemical  or  mechanical  irritant  is  not  at  once 
apparent  in  the  capillaries,  but  first  causes  contraction  of  the 
smaller  arteries,  and  sometimes  of  the  veins,  such  contraction 
being  followed  by  a  dilatation,  the  immediate  cause  of  which  is 
yet  obscure.  It  is,  however,  supposed  to  be  the  result  of  relaxa- 
tion or  a  temporary  paralysis  of  the  walls  of  the  vessels,  a  con- 
dition following  contraction,  and  which,  as  a  consequence,  causes 
a  decrease  of  their  resistance  to  the  pressure  of  the  blood  within 
them.  The  irritation  either  perverts  the  function  of  the  nerves 
of  the  vessels,  or  of  the  lining  cell  substance  of  the  capillary 
walls;  or  the  disturbance  is  due  to  reflex  action. 

Inflammation  denotes  an  abnormal  process  or  condition 
characterized  by  certain  changes  of  texture,  which,  although  uni- 
form in  type  differ  widely  in  appearance,  and  terminate  in  dif- 
ferent results,  according  to  the  nature  and  permanency  of  the 
causes  upon  which  such  a  condition  depends,  or  which  have 
given  rise  to  it. 

The  symptoms  of  inflammation  consist  of  the  phenomena  which 
accompany  the  textural  changes  characteristic  of  this  condition, 
and  its  pathology  the  textural  changes  which  occur  during  the 
continuance  of  this  condition.  The  essential  features  of  inflam- 
mation are  an  increased  afflux  of  blood  to  the  affected  part,  with 
a  greatly  increased  tendency  to  cell  proliferation  and  tissue  for- 
mation. 

The  causes  of  inflammation  determine  in  a  great  degree  its 
treatment  on  account  of  the  influence  they  exert  upon  its  de- 
structive tendencv,  and  they  may  be  classified  as  those  arising — 
1st,  from  mechanical  violence  ;  id,  from  irritating  and  destruc- 
tive   chemical    action ;   3d,  from    poisonous    infection,    and    the 


INFLAMMATION.  115 


effect  of  injurious  micro-organisms — the  latter  being  regarded  as 
"  immediate  determining  causes  of  the  more  destructive  phases 
of  the  inflammatory  process."  When  inflammation  owes  its 
origin  to  an  evident  injury,  or  the  reverse,  it  is  termed  traumatic^ 
or  idiopatbicy  and  when  no  apparent  cause  can  be  discovered  it  is 
termed  spontaneous. 

The  causes  of  inflammation  are  divided  into  predisposing  and 
exciting. 

Among  the  more  important  predisposing  causes  are  impoverished 
blood — defective  in  quality— such  as  may  result  from  a  want  of 
proper  food  and  of  fresh  air,  the  effects  of  such  deprivations  be- 
ing manifested  in  the  case  of  a  neglected  child  where  a  hard 
swelling  occurs  in  the  cheek,  which,  after  a  few  days,  presents  a 
gangrenous  condition,  constituting  the  disease  known  as  cancrum 
oris  or  gangranopsis.  On  the  other  hand  an  habitual  excess  of 
food  and  drink  is  also  a  predisposing  cause  of  inflammation,  the 
blood,  as  a  consequence,  being  impaired,  and  also  the  tissue 
which  it  supplies.  Blood  poisoning  is  also  another  predisposing 
cause,  resulting,  it  may  be,  from  the  presence  of  certain  diseases, 
such  as  syphilis,  diabetes,  mellitus,  eczema,  etc.  A  local  hy- 
peremia, constituting  the  first  stage  in  the  development  of  in- 
flammation, may  result  from  certain  poisons  in  the  blood,  which 
cause  it  to  stagnate  in  limited  areas,  through  an  inability  to  stimu- 
late the  heart  and  blood  vessels.  Syphilitic  ulceration  of  the 
mucous  membrane  of  the  mouth  is  an  example  of  such  a  predis- 
posing cause.  Weakened  vitality  of  parts  is  also  a  predisposing 
cause  of  inflammation  and  may  result  from  habitual  ill  feeding, 
protracted  illness,  overwork,  long  exposure  to  extreme  cold. 
Parts  such  as  the  mucous  membrane  of  the  mouth,  which  have 
already  been  the  seat  of  inflammation,  are  prone  to  such  a  con- 
dition subsequently,  from  slight  provocation. 

Defective  or  perverted  nervous  supply  may  also  be  regarded  as  a 
predisposing  cause  of  inflammation.  Certain  forms  of  skin  dis- 
ease, and  inflammatory  conditions  of  the  mucous  membrane  of 
the  mouth,  furnish  examples ;  also,  of  the  peridental  membrane 
of  the  teeth,  resulting  in  severe  periodontitis  and  alveolar  abscess. 

The    influence    of  climate    is    also    regarded  as  a  predisposing 


116  DENTAL  MEDICINE, 


cause,  for,  in  tropical  regions,  inflammation  of  certain  organs, 
often  terminating  in  abcesses,  are  very  prevalent.  The  mid- 
summer and  fall  months  are  considered  to  be  more  favorable  for 
surgical  operations,  on  account  of  the  comparative  absence  of 
inflammatory  complications  at  such  times. 

Jge  has  also  some  influence  as  a  predisposing  cause  of  inflam- 
mation. In  childhood  acute  hyperemia  is  induced  by  compara- 
tively slight  exciting  causes,  as  then  the  process  of  nutrition  is  at 
its  greatest  period  of  activity,  and  any  interruption  of  its  process 
is  followed  by  derangement  of  health. 

The  effects  of  the  irritation  of  the  first  dentition  may  be  ad- 
duced as  an  example.  Old  age  induces  weakness  in  the  tissues 
and  decrease  of  power  of  resistance  to  the  exciting  causes  of  in- 
flammation. 

Exciting  Causes  of  Inflammation. — These  causes  may  all  be  in- 
cluded in  the  condition  known  as  irritation  of  the  tissues,  result- 
ing from  irritants  of  various  kinds,  the  action  of  which  is  imme- 
diate in  producing  the  inflammatory  condition.  Exciting  causes 
may  be  divided  into  external^  which  are  easily  recognized,  and 
internal^  which  are  more  obscure,  and  are  assisted  by  some  pre- 
disposition of  the  organism. 

Cold  is  a  frequent  cause  of  inflammation,  and  its  effects  are 
due  to  sudden  changes  in  the  constitution  of  the  blood  from  an 
arrest  of  the  function  of  the  tissues,  temporary  in  its  nature, 
which  interferes  with  the  emunctory  action,  whereby  effete  and 
irritant  materials  which  should  be  eliminated  are  retained,  and 
poison  the  blood.  Heat  is  also  a  cause  of  inflammation,  its 
effects  varying  from  a  slight  redness,  denoting  transient  hyper- 
emia, to  vesication,  either  superficial  or  deep.  When  death  of 
tissue  results  from  such  a  cause,  suppuration  ensues  on  the  separa- 
tion of  the  eschar;  and  when  there  is  a  loss  of  cicatricial  power, 
repair  by  granulation  and  suppuration  (second  intention)  is  pre- 
vented. The  inflammation  resulting  from  simple  burns  and 
scalds,  provided  no  eschar  is  formed,  and  air  is  excluded,  soon 
subsides. 

Mechanical  violence  excites  inflammation  ;  yet,  under  favorable 
circumstances,  this  condition  resulting  from  an  incised  wound  is 


INFLAMMATION.  HJ 


soon  arrested,  owing  to  its  benign  form,  by  the  particles  of 
lacerated  tissue  being  carried  away  by  the  blood  and  the  subse- 
quent liquid  exudation,  while  those  that  remain  undergo  lique- 
faction and  absorption  by  the  lymphatics;  hence,  when  the  cut 
surfaces  are  brought  and  retained  in  proper  apposition,  speedy 
union,  by  the  '■'■  Jirst  intention^''  results.  Union  by  "  first  in- 
tention "  is  induced  by  such  changes  as  cell-proliferation,  the 
formation  of  new  capillaries,  and  the  generation  of  cicatricial 
tissue.  It  is  only  when  the  vitality  of  the  tissue  is  destroyed  and 
foreign  matters  left  in  the  wound,  especially  a  punctured  one, 
caused  by  a  rough  or  rusty  instrument,  that  there  are  complica- 
tions. The  tissues  themselves,  when  they  lose  their  vitality,  be- 
come irritants,  even  when  the  dead  matter  is  very  minute.  A 
boil  furnishes  an  example,  the  core  of  which  is  composed  mainly 
of  yellow,  elastic  fibres  with  some  leucocytes  or  pus  cells  in  the 
meshes.  This  mass  becomes  dead,  and  while  the  white  fibrous 
element  liquefies  and  mingles  with  the  pus,  the  yellow  fibres  re- 
main unchanged  and  constitute  the  irritant  body,  to  the  presence 
of  which  is  due  the  suppurative  inflammation.  The  presence 
of  a  clot  of  blood  in  a  wound  may  prevent  union,  and  cause  pus 
formation. 

Chemical  Irritants  excite  inflammation  by  first  causing  in- 
creased redness,  which  steadily  extends  and  becomes  more  intense 
until  a  considerable  diameter  is  attained.  There  is  also  increased 
heat  and  fullness  of  the  part  affected,  and  an  eschar  forms  as  the 
result  of  the  action  of  the  chemical  agent  upon  the  epidermis  in 
the  case  of  the  skin,  or  the  corium  in  the  case  of  mucous  mem- 
brane, the  depth  of  the  action  depending  upon  the  nature  of  the 
chemical  irritant.  After  one  or  two  days  the  narrow  circle  of 
redness  disappears,  and,  after  one  or  two  weeks,  the  eschar  sepa- 
rates, disclosing  an  area  of  smooth  cicatricial  tissue.  When  the 
action  of  such  irritants  is  slight,  repair  soon  follows,  without  the 
formation  of  an  eschar ;  but  when  their  action  is  severe  enough 
to  devitalize  the  tissue,  the  sloughs  are  thrown  off  without  sup- 
puration, if  the  parts  have  been  protected  from  the  air,  or  anti- 
septic applications  have  been  made. 

Mineral  irritants^  such    as   mercury  and  arsenic,  for  example. 


118  DENTAL  MEDICINE. 


cause  inflammation  by  a  process  different  from  that  of  chemical 
irritants.  The  inflammatory  action  of  mercury  and  arsenious 
acid  is  developed  only  after  the  poison  has  entered  the  circulation, 
and  a  certain  amount  has  been  received  by  the  stomach,  when 
active  inflammation  of  the  mouth  with  salivation  (mercurial 
stomatitis)  supervenes,  if  the  agent  is  mercury,  or  active  gastric 
hyperemia  with  vomiting,  if  the  agent  is  arsenic.  There  is  a 
specific  poisonous  action  brought  about  by  such  irritants,  on  ac- 
count of  the  tissues  of  the  mouth  and  stomach  being  more  sensi- 
tive to  the  influence  of  these  mineral  poisons.  The  cause  of 
this  peculiar  susceptibility  is  as  yet  obscure. 

Micro-organisms  are  capable  of  exciting  inflammation  by  direct 
contact  with  tissues,  when  the  latter  are  exposed  by  injury. 

Many  of  these  low  forms  of  life  are  indestructible  by  the 
most  extreme  heat  and  cold,  and  also  by  the  strongest  chemical 
agents.  And  whenever  the  oxygen  is  prevented  from  entering  a 
wound  these  micro-organisms  generate  with  great  rapidity,  and 
are  nourished  by  the  fluids  and  granulating  surfaces  which  sur- 
round them.  The  chemical  and  vital  changes  which  these  ani- 
mal materials  undergo  bring  about  putrefaction  through  the 
agency  of  fermentation,  and  certain  poisonous  combinations  are 
thus  formed.  These  micro-organisms,  therefore,  acting  as  a 
poison,  decompose  the  materials  generated  for  repair,  and  thus 
prevent  the  constructive  process;  they  also  act  as  a  putrefactive 
ferment,  producing  septic  poisons  destructive  in  their  action.  It 
has  been  definitely  determined  that  these  organisms,  although 
present  in  every  destructive  inflammation,  "do  not  occur  in  the 
blood  nor  in  the  tissues  of  the  healthy  living  body  of  man  or  of 
the  lower  animals."  Diminished  vitality,  whatever  may  be  the 
cause,  favors  the  invasion  and  development  of  micro-organisms 
in  the  form  of  parasites. 

While  some  of  the  common  parasites  cause  injurious  effects 
by  inciting  inflammation  in  tissues  and  organs,  they  only  act  as 
foreign  bodies,  while  the  microscopic  fungi  and  their  germs,  acting 
as  invisible  particles  of  organized  matter,  cause  the  greatest  in- 
jury. If  they  are  protected  from  the  influence  of  oxvgen,  these 
micro-organisms  germinate   very    rapidly,  and   derive  their  suste- 


INFLAMMATION.  HQ 


nance  from  the  fluids  of  the  inflamed  tissue  and  the  granulating 
surface.  The  form  known  as  vibrio  septica  generate  putrefaction 
in  animal  matter  by  bringing  about  a  process  of  fermentation — 
dental  caries  affords  an  example.  The  chemico-vital  changes 
accompanying  the  process  of  putrefactive  fermentation  give  rise 
to  septic  poisons^  which,  being  absorbed  in  the  circulation,  result 
in  septicemia  and  pyemia.  Dr.  Koch  affirms  that  "  bacteria 
do  not  occur  in  the  blood  nor  in  the  tissues  of  the  healthy 
living  body,  either  of  man  or  of  the  lower  animals,"  and  the 
same  investigator  also  says  :  "  When  introduced  by  inocula- 
tion into  animal  tissues,  they  multiply  and  excrete  solu- 
ble substances,  which  get  into  the  surrounding  tissues  by 
diff'usion." 

The  tissues,  by  the  contact  of  the  micrococci,  lose  their  vital- 
ity, and  the  parasite  growth  multiplies  and  spreads  rapidly  in  the 
dead  tissues,  advancing  directly  towards  the  parts  in  which  vital- 
ity yet  remains. 

Symptoms  of  Acute  Inflammation. — The  coexistence  of 
the  phenomena,  redness  and  heat^  with  swelling  and  pain^  the  or- 
dinary symptoms  of  inflammation,  may,  therefore,  be  considered 
as  sufficient  evidence  of  the  presence  of  the  inflammatory  condi- 
tion. The  absence,  however,  of  one  or  more  of  these  phenomena 
is  not  incompatible  with  the  existence  of  inflammation,  for  the 
increased  redness  and  heat  may  disappear  before  the  inflammatory 
process  ceases,  and  pain  be  sometimes  absent. 

The  redness  of  an  inflamed  part  is  usually  the  first  observable 
phenomenon,  and  one  of  the  most  characteristic  symptoms  of  in- 
flammation, and  one  also  that  is  persistent  and  due  to  hyperemia. 
It  varies  in  intensity,  according  to  the  degree  of  the  inflammatory 
process,  the  nature  of  the  part  affected,  the  condition  of  the  sys- 
tem, the  cause  of  the  inflammation,  the  freedom  from  obstruction 
in  the  vessels,  and  the  rapidity  of  the  circulation.  Of  a  light 
tint  in  the  early  stage,  it  becomes  deeper  as  the  inflammatory 
process  increases  in  degree,  until  every  grade,  almost,  of  redness 
is  observable,  ending  in  a  deep  crimson  or  even  purple.  It  may 
appear  in  points,  streaks,  in  minute  ramifications,  or  be  quite 
uniform  over  the  entire  surface  aff^ected.      Usually  it  is  more  in- 


120  DENTAL  MEDICINE. 


tense  in  one  spot,  gradually  fading  as  it  recedes,  until  lost  in  the 
surrounding  healthy  tissue;  in  other  cases  the  redness  has  an 
abrupt  boundary,  and  is  of  equal  intensity  over  its  entire  area. 
The  bright  hue  usually  attends  ordinary  active  inflammation  j  the 
dark  or  purplish  hue  that  form  of  inflammation  proceeding  from 
some  specific  cause,  or  associated  with  a  gangrenous  tendency, 
and  indicates  stasis.  The  redness  of  inflammation  is  caused  by 
the  increased  amount  of  blood  entering  the  vessels  of  the  part, 
and  remaining  there  for  a  longer  time  than  is  natural  under  other 
conditions. 

The  Heat  of  an  inflamed  part  is  also  caused  by  the  unusual 
quantity  of  red  blood  present,  and  also  by  an  increase  of  that  vital 
action  upon  which  the  evolution  of  heat  depends,  namely,  super- 
oxidation  of  the  affected  tissues,  resulting  in  their  decomposition. 
It  is  more  marked  at  the  focus  of  the  inflamed  area.  The  in- 
crease of  temperature  is  generally  more  sensible  to  the  suff^erer 
than  to  the  observer,  though  it  may  often  be  detected  by  the 
hand,  and  is  very  evident  by  the  use  of  the  clinical  thermometer; 
it  is  also  verified  by  comparison  with  other  unaffected  parts ;  but 
is  never  beyond  the  temperature  of  the  internal  organs. 

The  Swelling  of  an  inflamed  tissue  is  caused  in  part  by  the 
unusual  quantity  of  blood  present  in  the  dilated  vessels, — the  en- 
gorgement of  the  blood  vessels  of  the  part,  and  also  by  the  mat- 
ters, both  liquid  and  solid,  which  exude  into  the  affected  tissue 
through  the  walls  of  the  dilated  vessels,  and  also  to  extravasation 
resulting  from  rupture  of  these  walls;  for  as  the  vessels  are  dis- 
tended their  walls  become  thinner,  and  permit  the  blood  plasma 
to  escape  through  them  in  greater  quantity  than  is  required  for 
mere  nourishment ;  hence  the  inflamed  tissue  becomes  infil- 
trated with  this  plasma,  the  consequence  of  which  is  an  increase 
of  thickness  or  swelling.  The  swell  of  a  part,  however,  without 
other  symptoms  is  not  an  evidence  of  inflammation,  as  this  phe- 
nomenon may  occur  from  other  causes.  Swelling  may  also  be 
absent  when  the  other  symptoms  of  inflammation  are  present,  an 
example  of  which  is  afforded  in  inflammation  of  mucous  mem- 
branes, before  exudation  has  occurred  in  the  connective  tissue 
beneath.     The  swelling   is  soft  in  acute  inflammations,  and  hard 


INFLAMMATION.  121 


in  the  chronic  form,  being  especially  marked  in  loose  connective 
tissue. 

The  Pain  of  inflammation,  which  is  persistent,  and  increased 
bv  pressure,  motion,  or  exercise,  is  mainly  due  to  mechanical 
pressure  upon  the  nerve-filaments ;  and  exercise  increases  the  ar- 
terial tension  and  augments  the  pain.  Every  tissue  is  supplied 
u'ith  sensory  nerves,  and  the  pain  resulting  from  irritation  and 
injury  varies  considerably,  in  accordance  with  the  nature  of 
the  part  and  its  supply  of  nervous  filaments.  Parts  having  little 
sensibility  in  a  normal  condition,  often  become  extremely  painful 
when  inflamed  ;  the  gums  afford  a  well  marked  example.  When 
the  parts  are  unyielding,  as  in  periodontitis,  the  pain  becomes 
very  severe  ;  and  a  pulsating  or  throbbing  pain  is  caused  by  the 
increased  force  of  the  smaller  vessels  conveying  the  blood  to  the 
focus  of  inflammation,  and  also  the  obstruction  of  the  circulation 
produced  by  the  swelling  and  increased  by  the  stasis  at  the  focus 
of  the  affected  area.  When  the  veins  of  an  inflamed  part  become 
obstructed  by  the  swelling,  bringing  about  pressure  to  such  a 
degree  as  to  prevent  the  blood  from  passing  through  them,  the 
quantity  being  constantly  increased  by  the  supply  from  the  arter- 
ies, a  condition  of  strangulation  results,  in  which  the  pain  is  very 
severe. 

We  find  an  example  of  this  condition  of  strangulation  in  pul- 
pitis, or  inflammation  of  the  pulps  of  the  teeth.  Pain  is  also  gener- 
ally present,  even  in  the  case  of  soft  tissues  affected  with  inflamma- 
tion, and  where  every  advantage  is  afforded  for  their  swelling  ;  the 
oral  mucous  membrane  is  an  example.  There  is  also  pain  of  an 
itching  character,  in  certain  forms  of  inflammation  of  mucous  mem- 
branes ;  also  boring  pain  in  the  neighborhood  of  joints.  The  pain 
of  alveolar  abscesses,  when  they  slowly  form,  is  often  of  a  tensive 
character,  and  generally  becomes  lancinating  when  they  are  about 
to  point;  and  in  all  such  cases  is  useful  in  determining  the  seat 
of  the  suppurative  process.  At  times  the  pain  is  reflected  to  parts 
remote  from  the  seat  of  inflammation,  as  otalgia  in  pulpitis,  etc. 

The  acute  form  of  inflammation  may  change  to  the  subacute 
and  finally  to  the  chronic,  examples  of  which  are  presented  in  the 
different  stages  of  pulpitis  and  periodontitis.     The  constitutional 


122  DENTAL  MEDICINE. 


symptoms  of  acute  inflammation  are  sthenic  and  asthenic  fevers  : 
the  sthenic  being  characterized  by  full,  strong,  rapid  pulse,  in- 
creased temperature,  flushed  face,  injected  conjunctiva,  headache, 
lumbar  pains,  interrupted  sleep,  diminished  secretions,  dark  col- 
ored urine,  thirst,  tongue  coated  white  or  yellowish,  and  con- 
stipation ;  and  is  common  in  the  strong  and  robust. 

Asthenic  fever  is  characterized  by  a  feeble  pulse,  a  fluctuating 
temperature,  a  dull,  torpid,  and  at  times  delirious  mental  condition, 
the  tongue  dry  and  coated  with  a  brown  or  black  fur ;  and  is 
common  in  the  very  young  and  feeble  and  old  persons. 

The  fever  of  inflammation,  also  known  as  "traumatic,"  is  very 
generally  present  when  the  inflammation  is  severe,  or  the  injury 
occasioning  it  is  extensive  and  complicated.  This  inflammatory 
fever  generally  makes  its  appearance  in  from  twelve  to  twenty-four 
hours  after  the  injury  is  received,  or  when  the  inflammatory  proc- 
ess is  at  its  height  ;  and  when  the  parts  have  previouslv  been 
healthy,  and  the  inflammation  limited,  it  is  moderate  in  its  char- 
acter and  soon  terminates  spontaneously.  This  fever  is  indic- 
ative' of  the  introduction  into  the  system  of  poisonous  substances 
resulting  from  the  pathological  changes  in  the  exudates  or  the 
fixed  tissue  cells,  on  account  of  the  action  of  the  specific  micro- 
organisms. The  symptoms  of  inflammatory  fever  are  a  feeling 
of  fatigue,  restlessness,  thirst,  hot  and  dry  mouth,  coated  tongue, 
urine  scanty,  but  deeper  in  color,  frequent  pulse,  temperature 
about  100°  F.;  and  the  fever  usually  reaches  its  climax  in  about 
thirty-six  hours,  when  it  begins  to  decline,  and  by  the  sixth  or 
seventh  day  has  disappeared.  In  the  case  of  an  abscess,  it  fre- 
quently happens  that  when  suppuration  occurs  the  fever  begins  to 
decline.  Should  the  fever  continue  longer  than  the  time  referred 
to,  the  cause  may  generally  be  due  to  deeper  suppuration  and 
other  complications  of  the  local  affection.  During  the  inflamma- 
tory process,  when  putrescent  matter  has  been  absorbed  by  the 
blood  in  greater  quantity  than  can  be  resisted  or  gotten  rid  of  by 
the  organism,  and  there  is  no  escape  from  it  by  drainage,  the 
symptoms  of  inflammatory  fever  become  more  intense,  and  a  con- 
dition of  septic  poisoning  takes  place,  known  as  septicemia.  When 
some  time  has  elapsed  after  the  inception  of  the  inflammatory 


INFLAMMATION.  123 


process,  and  the  characteristic  fever  has  almost  disappeared,  a 
chill  suddenly  occurs,  followed  by  profuse  perspiration,  the  con- 
dition known  as  pyemia  is  present — pus  globules  in  the  blood. 

Exudation. — Exudation  is  a  process  by  which  the  corpuscular 
elements  of  the  blood  and  the  liquor  sanguinis  pass  through  the 
walls  of  the  blood  vessels  into  the  tissues  beyond,  and  results  from 
changes  in  the  walls  of  the  vessels,  which  permit  the  oozing  of 
the  blood  through  their  walls —  "  the  loss  of  the  power  by  the 
vessels  of  resistance  to  dilatation,  and  the  loss  of  vital  power,  in 
consequence  of  which  leakage  takes  place."  The  symptom  of 
swelling  is  in  great  part  due  to  exudation.  The  exudation  in 
what  is  termed  "  healthy  inflammation,"  and  known  as  plastic  or 
coagulable  lymph.,  seen  on  the  surface  of  a  recent  wound  or  in  the 
form  of  swelling  around  a  centre  of  imflammation,  is  a  mild  and 
unirritating  product,  the  function  of  which  is  to  form  new  tissues 
for  repair,  called  at  first  granulations.  Inflammatory  exudations 
from  free  surfaces  of  mucous  membranes  contain  mucus,  and 
a  substance  known  as  mucin.,  in  the  form  of  filaments,  insoluble 
in  acetic  acid.  The  inflammatory  effusion  known  as  plastic  or 
coagulable  lymph.,  the  true  indicator  of  a  healthy  constructive  proc- 
ess, is  soon  converted  from  a  jelly-like  substance,  by  the  germinal 
power,  into  a  mass  of  living  cells,  through  which  other  minute 
cells,  which  are  to  form  the  capillaries,  make  their  way  like  a  small 
stream,  the  primitive  living  cells  flattening  out,  and  making  walls, 
apparently,  for  the  forming  vessels.  These  new  capillaries  pen- 
etrate the  mass  of  germinal  cells  in  large  numbers,  like  delicate 
connecting  threads,  and  furnish  the  blood  supply  to  the  organ- 
izing mass,  which  becomes  converted  into  new  or  young  connec- 
tive tissue.  This  tissue  drawing  and  binding  together  the  opposite 
sides  of  the  wound  then  becomes  the  cicatricial  tissue,  which 
originates  from  the  cement-like  material  furnished  by  the  inflam- 
matory exudation.  The  cicatricial  tissue  becomes  invested,  in 
the  case  of  oral  mucous  membrane,  with  epithelium,  bv  a  similar 
process  of  cell  growth  and  development  ;  and  this  is  the  process 
of  union  by  the  first  intention.  The  cicatrix  or  scar  is  redder 
than  natural,  owing  to  the  large  number  of  vessels  :  but  when  the 
supply  of  blood  is  no  longer  needed  in  such  quantity  as  is  at  first 


124  DENTAL  MEDICINE. 

necessary,  the  capillaries  diminish  and  disappear,  so  that  the 
cicatrix  grows  paler  and  of  smaller  bulk.  In  the  case  of  an  abra- 
sion of  the  skin,  the  exuding  plastic  lymph  dries  upon  the  denuded 
surface  when  not  disturbed,  and  forms  a  protecting  crust,  which 
at  length  falls  off,  exposing  a  reddish  surface  covered  with  epider- 
mis. In  the  case  of  the  oral  mucous  membrane,  a  like  result  is 
produced  under  the  protection  of  the  mucous  secretions  peculiar 
to  such  a  tissue. 

Suppuration. — Suppuration  is  the  formation  of  pus,  and  is  the 
most  frequent  termination  of  acute  inflammation,  and  is  a  process 
by  which  the  leucocytes  and  the  embryonic  cell  formed  from  the 
fixed  tissue-cells  are  converted  into  pus-corpuscles  and  the  inter- 
cellular substance  of  the  tissues  undergoes  liquefaction. 

When  pus  forms  an  abscess,  owing  to  some  chemical  substance 
in  its  composition,  it  exerts  a  solvent  action  upon  the  tissues, 
which  is  shown  by  the  presence  of  broken-down  tissue  cells 
and  remains  of  tissue,  mixed  with  pus-corpuscles.  Suppuration  is 
directly  caused  by  the  action  of  certain  specific  micro-organisms, 
and  also  by  certain  chemical  irritants  introduced  under  the  skin. 
The  formation  of  pus  is  a  result  of  destructive  inflammation, 
as  the  presence  of  such  a  fluid  denotes  a  loss  of  substance,  which 
does  not  occur  when  a  wound  heals  by  the  first  intention.  Under 
favorable  circumstances  an  inflamed  surface,  when  destruction  of 
tissue  has  occurred,  heals  by  the  process  of  the  second  intention,  as 
follows  :  A  soft,  red  surface  of  coagulable  lymph  becomes  organ- 
ized into  embryonic  tissue,  which  is  known  as  granulation  tissue.^ 
and  the  yellowish  fluid,  bland  in  nature,  which  is  present,  is  pus ; 
these  materials,  or"  products  of  inflammation,"  being  generated  for 
reparative  processes.  The  granulation  tissue  is  composed  of  em- 
bryonic cells  and  a  network  of  capillary  loops,  about  which  are 
clustered  a  number  of  living  leucocytes  held  together  by  a  delicate 
intercellular  material,  by  which  the  tissue  receives  its  supply  of 
nutritive  matter  from  the  blood,  so  that  it  may  become  what  is 
recognized  later  as  the  cicatricial  tissue,  or  one  of  a  higher  organ- 
ism than  the  granulation  tissue.  The  healthy  granulation  tissue 
is  of  a  variable  pinkish,  or  cherry-red  color,  the  tint  depending 
upon  the  quality  of  the  blood  which  its  vessels  contain,  and  is  of 


INFLAMMATION.  125 


a  jelly-like  consistence,  and  somewhat  smooth  and  firm.  Its 
surface,  when  in  a  normal  condition,  is  studded  over  with  small 
conical  prominences  called  granulations^  in  which  very  minute 
vessels  are  situated  very  superficially.  Healthy  granulations  are 
also  non-sensitive,  elastic,  and  discharge  laudable  pus.  Unhealthy 
granulations  are  coarse,  dark  red  in  color,  and  bleed  readily. 

Pus  of  a  yellow  color  is  found  between  the  granulations,  which 
vary  in  size,  form  and  color,  a  moderate  bright-red  color  being  in- 
dicative of  a  healthy  healing  process. 

When  there  is  a  want  of  power  in  the  process  of  forming  the 
cicatricial  or  repair  tissue,  the  granulations  become  large  and  trans- 
lucent, and  the  pus  which  surrounds  them  is  pale  and  thin.  If 
the  affected  surface  is  exposed  to  friction,  or  irritation  from  other 
causes,  the  granulations  become  extremely  small  and  of  a  deeper 
red  color  than  is  normal,  and  at  length  may  disappear  at  points, 
leaving  grayish  spots  or  smooth  patches.  If  the  process  of 
cicatrization  is  prevented  in  its  first  stage,  the  granulations  become 
large  and  coalesce,  protruding  and  overhanging  the  edges  of  the 
wound,  and  forming  what  is  commonly  known  as  "  proud  flesh." 
During  the  entire  healing  process  a  flow  of  pus  is  going  on  from 
the  affected  surface  as  a  normal  act,  and  the  first  appearance  of  it 
is  indicative  of  repair.  Its  appearance  is  also  coincident  with  the 
organization  of  plastic  lymph.  When  the  suppuration  is  well 
established,  the  heat,  tension  and  swelling  of  the  inflamed  part  be- 
comes less  in  degree,  and  the  frequency  of  the  pulse  and  the  tem- 
perature of  the  body  diminish.  Whenever  the  granulating  sur- 
face is  formed,  union  by  the  second  intention^  or  second  adhesion^  as 
it  is  termed,  will  take  place,  if  separated  surfaces  are  brought  into 
apposition. 

Origin  and  Characteristics  of  Pus. — Pus  is  a  secretion  furnished 
by  the  blood  at  the  expense  of  the  tissues,  an  exuberant  quantity 
of  plastic  material,  for  which  excess  there  is  no  demand  in  the 
reparative  process.  The  leucocytes  which  are  brought  to  the 
surface  of  a  granulating  wound  are  discharged  from  it  in  the  form 
of  pus,  while  those  that  remain  behind  develop  into  tissue.  This 
effect,  by  which  the  excess  of  leucocytes  is  gotten  rid  of,  is  ac- 
complished by  liquid  exudation,  the  supply  of  which  comes  from 


126  DENTAL  MEDICINE. 

the  newly-formed  and  the  old  capillaries,  and  is  the  same  force 
that  carries  the  nutritive  material  to  the  tissues.  Healthy  pus  is 
of  a  yellowish-white  color,  sometimes  assuming  a  pale  greenish 
tint,  of  cream-like  consistence ;  a  slightly  saltish  taste,  but  some- 
what sweet ;  a  faint  animal  odor,  with  an  alkaline  reaction.  The 
presence  of  bile  may  give  to  pus  a  deep  orange  color,  while  all  of 
the  other  shades  are  due  to  the  coloring  matter  of  the  blood, 
known  as  haematoidin.  As  long  as  the  air  has  access  to  it,  there 
is  little  tendency  to  putrefaction  ;  and  even  when  it  is  removed 
from  the  body  and  exposed  to  ordinary  temperature,  change  in  it 
occurs  very  slowly.  Pus  consists  of  two  portions — a  solid  portion, 
know  as  pus  corpuscles^  and  which  consists  almost  entirely  of 
young  pus  cells  or  leucocytes,  and  a  liquid  portion  known  as 
liquor  puris^  which  is  a  serous  fluid,  and  constitutes  about  three- 
fourths  of  its  bulk. 

When  pus  is  subjected  to  pressure,  as  sometimes  occurs  in  ab- 
scess of  the  antrum,  and  about  bones,  it  may  become  a  yellowish, 
cheesy  mass,  owing  to  the  compression  of  the  pus  cells.  The 
solid  portion  of  pus  consists  of  more  than  nine-tenths  of  leucocytes 
or  young  pus  cells,  which,  in  freshly  formed  pus,  presents  under 
the  microscope  a  granular  appearance,  and  also  the  peculiar 
movements  of  active,  young  and  healthy  leucocytes ;  but  pus 
which  has  collected  in  an  abscess  for  several  days  shows  no  such 
movements,  thereby  indicating  that  the  leucocytes  have  died. 
Living  and  dead  pus  cells  may  be  found  in  ordinary  pus,  mingled 
together.  The  most  common  forms  of  micro-organisms  which 
produce  suppuration  are  the  staphylococci  and  the  streptococci. 

Varieties  of  Pus. — The  constitution  of  pus,  which  is  subject  to 
constant  change,  depends  upon  the  form  of  the  disease,  the  lo- 
cality and  the  condition  of  the  patient.  When  pus  is  of  a  yel- 
lowish-white color,  of  the  consistence  of  cream,  and  composed  of 
a  great  number  of  pus  globules,  it  is  called  "  healthy,"  "  pure," 
or  "  laudable."  When  pus  is  thin,  reddish  and  mixed  with  blood, 
it  is  termed  "sanious"  pus,  and  is  common  to  diseases  of  the 
bones,  irritable  ulcers,  etc.,  and  Is  also  frequently  mixed  with 
particles  of  fibrin,  and  dead  tissue.  In  chronic  and  cold  abscesses 
the  pus-corpuscles  become  pale  and  watery,  showing  that  they  are 


INFLAMMATION.  121 


undergoing  solution ;  the  pus  from  epithelial  tumors,  indolent 
ulcers,  and  phagedenic  ulcers,  is  thin  and  sanious,  and  contains 
more  or  less  dead  tissue,  which  prevents  the  repair. 

Thin,  watery,  acrid  pus  is  termed  "  ichorous,"  and  is  common 
to  chronic  ulcers,  bone  diseases,  etc.  Thin,  watery  pus  from  in- 
flamed mucous  membrane,  is  termed  "  muco-pus."  Thin,  watery 
pus,  containing  fibrin  and  coming  from  serous  membranes,  is  termed 
"  sero-pus."  Thick,  ropy  pus  from  syphilitic  abscesses,  is  termed 
•■'gummy  pus."  Sanious  pus,  containing  flakes  of  coagulated  fi- 
brin, common  to  chronic  abscesses,  and  bone  disease,  is  termed 
"  curdy  "  or  "  cheesy  "  pus. 

Abscess. — The  term  abscess  denotes  a  collection  of  pus  in  the 
substance  of  the  tissues,  surrounded  by  a  wall  of  lymph.  The 
formation  of  the  acute  form  is  as  follows  :  The  exciting  cause, 
acting  as  an  irritant,  induces  an  afflux  of  blood  to  the  centre  of 
the  affection,  and  the  distended  capillaries  pour  out  liquid  exuda- 
tion, which  coagulates  at  this  centre  into  plastic  lymph,  expand- 
ing the  meshes  of  the  neighboring  surrounding  tissues  with  a 
more  serous  fluid. 

Leucocytes  are  formed  from  cell  proliferation  in  the  plastic 
lymph  ;  but,  on  account  of  their  not  being  in  a  proper  place  for 
their  growth  and  development  into  tissue,  they  become  changed 
into  pus,  which  collects  in  a  cavity  formed  by  it,  and  the  result 
is  an  abscess.  As  these  phenomena  occur  in  rather  quick  suc- 
cession, pain,  heat,  redness  and  swelling  are  present,  and  also 
constitutional  disturbance  in  the  form  of  hectic  fever. 

The  increase  of  an  abscess  in  size  is  attended  with  a  certain 
amount  of  redness  on  the  surface  over  it  and  to  which  it  is  ap- 
proaching, this  increasing  redness  being  preceded  by  more  or  less 
oedema  of  the  tissue  beneath,  which  is  owing  to  the  protruding  of 
the  serous  exudation  surrounding  the  central  collection  of  pus. 
The  centre  of  the  surface  redness  then  presents  a  more  prominent 
and  elevated  point,  where  the  outer  tissue  becomes  thinner, 
purplish,  or  livid,  and  soon  the  yellow  pus  within  is  visible 
through  it — a  condition  to  which  the  term  pointing  is  applied. 
Soon  after  the  "  pointing,"  the  integument  gives  way,  and  the 
pus  exudes  through  the  opening  thus  made. 


128  DENTAL  MEDICINE. 


This  thinning  and  weakening  of  the  surface  is  caused  by  the 
stretching  and  obstruction  of  the  blood  vessels,  which  convey  the 
nutritive  supply  from  beneath,  by  the  pressure  of  the  enlarging 
abscess  to  such  a  degree  that  the  surface  integument  is  de- 
prived of  its  blood  and  slowly  dies  by  minute  particles,  the  dead 
material  being  added  to  the  contents  of  the  abscess. 

An  abscess  unattended  with  such  symptoms  as  pain,  heat,  and 
redness,  is  termed  a  cold  abscess^  and  its  presence  depends  upon  a 
low  degree  of  vitality.  Such  an  abscess  presents  the  same 
phenomena  of  pus  formation  as  the  acute  form,  but  resembles 
more  the  growth  of  a  tumor,  as  all  the  symptoms  mav  be  absent 
except  the  swelling.  The  formation  of  pus  on  the  surface  of  a 
tissue,  such  as  mucous  membrane,  is  not  so  serious  as  that  in  an 
abscess,  as  the  conversion  of  the  leucocytes  into  pus  requires 
but  little  more  increased  activity  than  in  cell  germination.  The 
exudation  takes  place  from  the  network  of  capillaries  which  exist 
beneath  every  mucous  membrane,  and  which  furnishes  nourish- 
ment for  the  constant  renewal  of  the  epithelium,  and  any  injury 
received  causes  a  fluxion  of  blood  to  the  capillaries,  which  in- 
creases the  cell  proliferation.  The  effect  is,  then,  to  promote  an 
increased  discharge  from  the  surface  of  the  membrane,  in  the 
form  of  pus.  Suppuration  from  mucous  membrane  usually 
causes  pain,  heat,  imcreased  redness,  and  swelling  of  the  in- 
flamed surface,  owing  to  the  exudation  into  the  meshes  of  the 
connective  tissue  beneath,  and  recovery  is  characterized  by  di- 
minished fluxion  of  blood  to  the  affected  part,  and  consequent 
lessening  of  cell  production  ;  the  cells  resume  their  function  of 
producing  epithelial  tissue,  the  pus  becomes  thin  and  more 
fluid,  and  finally  ceases  when  the  normal  conditions  again  appear. 

Hectic  fever  is  a  symptom  of  destructive  inflammation,  and  is  a 
persistent,  low  form  of  continued  fever,  characterized  by  remis- 
sion and  exacerbation  morning  and  night.  This  form  of  fever  is 
caused  by  absorption  into  the  blood  of  some  of  the  products  of 
inflammation,  in  such  quantities  and  so  gradually  as  not  to  produce 
an  immediate  fatal  result,  and  inducing  a  regular  succession  of 
chill,  fever,  and  perspiration  during  the  space  of  every  twenty- 
four  hours.     Its  effect   is   progressive  emaciation  and  a  tendency 


INFLAMMATION.  129 


to  fatal  termination,  if  the  cause  is  not  removed,  through  com- 
bustion of  tissue  material  to  supply  the  fever  heat.  The  regular- 
ity of  the  night  sweats,  and  the  pulse  retaining  its  frequency 
during  the  apyrexia,  even  in  the  morning,  when  the  temperature 
is  normal,  are  the  diagnostic  signs  of  hectic  from  typhoid  and 
malarial  fevers. 

The  most  unfavorable  symptoms  of  hectic  fever  are  the  higher 
fever  in  the  evening,  the  increase  in  the  frequency  of  the  pulse, 
the  more  exhausting  night  sweats,  with  the  occurrence  of 
aphthae  in  the  mouth,  and  diarrhoea. 

Chronic  Inflammation. — Chronic  or  asthenic  inflammation 
is  a  process  in  which  all  the  cardinal  symptoms  of  inflammation 
may  be  present,  but  in  less  degree  than  in  the  acute  form,  by 
which  it  is  generally  preceded.  In  chronic  inflammation  there 
is  present  a  permanent  local  hyperaemia,  attended  with  an  exuda- 
tion into  the  interstices  of  the  inflamed  part,  or  from  its  surface. 
The  pain  in  this  form  is  usually  light,  or  may  be  intermittent,  or 
even  absent,  or  be  no  more  than  an  itching  sensation ;  heat  is 
present,  but  is  not  a  prominent  symptom;  the  redness  is  of  a 
light  hue,  sometimes  livid,  from  passive  hyperaemia  and  the 
stretching  of  the  vessels  by  the  over-distention  to  which  they 
had  before  been  subjected,  and  the  diminished  force  of  the  circu- 
lation ;  the  swelling  is  in  the  form  of  induration,  owing  to  the 
exudation  having  become  organized  into  tissue.  This  latter  ac- 
counts for  the  hardness  around  an  indolent  ulcer,  and  an  old 
sinus.  Inflammatory  induration  is  a  process  of  hardening  the 
tissues  due  to  coagulation  of  the  fibrinous  elements  of  the  exu- 
dates or  the  fixed  tissue  cells,  and  new  formations  in  the  con- 
nective tissues.  In  mucous  membranes  induration  is  indicative 
of  chronic  inflammation,  and  is  caused  by  exudative  infiltration 
into  the  substance  of  the  submucous  connective  tissue,  and  a 
considerable  change  of  structure  in  these  membranes  often 
occurs.  Although  the  symptoms  of  chronic  inflammation  are 
present  in  a  limited  degree,  yet  they  are  more  persistent,  on  ac- 
count of  the  object  for  which  the  increased  nutritive  effort  was 
made  proving  unsuccessful.  Causes. — The  causes  of  chronic  in- 
flammation are  long-continued  irritation,  functional  activity,  and 
9 


130  DENTAL   MEDICINE. 


constitutional  dyscrasia,  or  diathesis;  and  its  terminations  are 
induration,  hypertrophy,  tumefaction,  suppuration,  ulceration, 
fatty  degeneration,  the  formation  of  cold  abscesses,  and  casea- 
tion. The  local  symptoms  differ  from  those  of  the  acuter  form 
only  in  the  degree  of  severity. 

Terminations  of  Inflammation. — According  to  the  present  knowl- 
edge of  this  subject,  inflammation  terminates — ist,  By  Resolu- 
tion ;  2d,  By  Suppuration;  3d,  By  Formation  of  New  Tissue;  4th, 
By  Gangrene  or  Local  Death — Necrosis.  When  the  inflammatory 
process  terminates  by  resolution.,  all  of  the  symptoms  gradually 
diminish  and  disappear,  and  the  affected  tissues  resume  their 
normal  condition.  Such  a  result  is  generally  due  to  the  mild 
character  of  the  injury,  and  the  progress  of  the  inflammation. 
Resolution  is  the  most  favorable  ending  of  inflammation  and  is 
established  as  soon  as  the  blood  which  circulates  through  the 
vessels  restores  their  walls  to  a  healthy  state. 

When  the  inflammatory  process  terminates  by  suppuration.^ 
there  is  a  loss  of  substance,  and  after  the  discharge  of  the  pus, 
a  more  extensive  process  of  repair  is  required  to  produce  a  heal- 
ing of  the  wound  by  the  growth  of  granulation  tissue,  and  the 
formation  of  the  cicatrix.     (See  Suppuration  and  Abscess.) 

When  the  inflammatory  process  terminates  by  the  formation 
of  new  tissue.,  the  new  growth  is  produced  by  inflammation — 
either  by  the  union  by  first  intention,  or  by  the  development  of 
granulations,  which  become  organized  into  a  cicatrix. 

When  the  inflammatory  process  terminates  in  gangrene  or  local 
death.,  the  effort  of  the  inflammation  toward  repair  has  failed, 
either  on  account  of  the  functions  of  the  capillaries  and  the  con- 
nective tissue  becoming  impeded  to  such  a  degree  as  to  render 
inoperative  the  resources  of  the  organisms,  or  because  of  certain 
conditions  arising  at  a  later  period  which  have  obstructed  the 
reparative  effort  and  caused  the  parts  to  lose  their  vitality. 

The  termination  of  the  inflammatory  process  by  gangrene  de- 
pends upon  the  degree  and  nature  of  the  lesion,  and  the  inability 
of  the  capillaries  and  arteries  to  maintain  the  local  circulation. 
The  impairment  of  the  vitality  of  the  blood  vessels  causes  stasis 
and  thrombosis  to  occur,  and  as  soon  as  actual  death  takes  place, 


INFLAMMATION.  131 


the  dead  tissue  presents  a  further  obstacle  to  the  local  circulation, 
and  also  adds  to  the  difficulty  of  elimination,  which  favors  the 
spread  of  the  gangrene.  The  earliest  symptoms  of  gangrene  are 
hard  swelling,  burning  and  tensive  pain,  and  livid  color.  The 
pain  then  subsides,  vesications  appear,  the  part  takes  on  a 
marbled,  purplish-yellow  color,  afterward  becoming  brown  or 
grayish,  and  finally  cold  and  insensible,  exhaling  a  putrid  odor. 
(See  Gangrene,  Necrosis  of  Bone,  and  Caries  of  Bone.) 

Treatment  of  Inflammation. — It  has  already  been  stated 
that  the  causes  of  inflammation  determine  in  a  great  measure  its 
treatment,  and  this  is  especially  true  of  inflammation  of  the  oral 
mucous  membrane.  As  acute  inflammation  is  now  recognized 
as  the  result  of  the  action  of  certain  specific  micro-organisms, 
both  prophylactic  and  curative  treatment  by  antiseptic  methods  is 
very  satisfactory.  The  old  method  of  antiphlogistic  treatment 
has  given  place  to  antiseptic  treatment,  although  some  of  the 
older  measures  are  still  employed,  and  may  occasionally  be  used 
to  advantage  in  relieving  certain  symptoms  of  inflammation,  and 
thus  favoring  a  return  to  the  normal  condition.  The  indications 
of  treatment  are  as  follows  : 

Prophylactic  Treatment^  which  consists  in  protecting  avenues 
of  infection  against  the  entrance  of  pathogenic  micro-organisms 
into  tissues  deprived  of  their  natural  coverings,  such  as  the  skin 
and  mucous  membrane,  by  first  securing  an  aseptic  condition  of 
the  parts,  and  maintaining  this  by  thorough  sterilization.  Inflam- 
mation is  prevented  if  pus-forming  microbes  are  excluded  so 
thoroughly  as  to  prevent  their  infection  of  wounds.  Prevention 
may  also  include  the  removal  of  a  predisposing  cause  when  local, 
or  the  lessening  of  its  effects  when  it  is  general  or  constitutional. 
If  malaria  is  present,  quinine  is  indicated;  if  syphilis,  iodide  of 
potassium,  or  minute  doses  of  bichloride  of  mercury.  Irritation, 
the  precursor  of  inflammation,  may  often  be  arrested  by  the  re- 
moval of  a  local  cause,  such  as  salivary  calculus,  or  the  removal 
of  diseased  teeth,  or  of  foreign  substances,  for  example. 

Curative  Treatment  consists  of  both  local  and  constitutional 
measures.  The  restoration  of  the  secretion  of  the  different 
organs  is  indicated  in  the  treatment  of  certain  forms  of  inflamma- 


132  DENTAL  MEDICINE. 


tion,  and  also  the  use  of  such  palliative  remedies  as  will  allay  the 
excitement  of  the  nervous  system.  When  the  cause  is  apparent, 
its  removal  is,  as  a  general  rule,  easily  accomplished  ;  but  when 
the  cause  is  obscure,  the  condition  of  the  secretions  of  the  bowels 
and  the  diet  should  receive  careful  attention.  To  correct  the 
secretions,  purgatives  are  indispensable;  also  such  other  depletory 
measures  as  bleeding,  abstinence  from  food,  use  of  emetics  or 
nauseants  to  lessen  the  general  circulation  and  reduce  the  vascu- 
lar tension.  To  allay  the  nervous  excitement  and  irritability, 
anodynes,  narcotics  or  opiates  are  indicated,  their  direct  effect 
being  relief  of  pain  and  spasm,  and  inducement  to  rest  and 
tranquillity. 

Local  Treatment. — The  advantage  of  rest  and  immobility  cannot 
be  overestimated,  for  a  simple  lesion,  if  subjected  to  constant 
mobility,  may  become  one  of  a  much  greater  character,  destruc- 
tive inflammation  often  being  provoked  by  friction  and  undue 
motion.  An  example  is  furnished  in  the  case  of  periodon- 
titis, where  a  cap  or  partial  interdental  splint  made  of  model- 
ing composition  or  gutta  percha,  or  vulcanized  rubber,  will  pro- 
tect the  affected  tooth  from  irritation,  and  materially  assist  the 
remedial  measures ;  also  strips  of  adhesive  plaster,  collodion,  etc., 
will  insure  immobility  in  certain  cases  where  such  appliances  are 
indicated,  as  undue  motion  retards  and  prevents  the  process  of 
healing. 

Position  is  also  to  be  considered  as  a  means  for  relieving  the 
irritation  and  pain,  so  that  no  provocation  may  exist  for  subse- 
quent inflammation.  The  best  position  should  be  selected  for 
the  affected  part,  which  will  favor  the  return  of  venous  blood 
and  retard  the  arterial  current ;  hence,  an  elevated  position  will 
tend  to  prevent  passive  hyperaemia.  A  favorable  position  will 
also  secure  muscular  relaxation,  and  prevent  the  involuntary 
spasmodic  action,  which  may  result  from  muscular  tension.  The 
administration  of  an  anaesthetic  to  secure  muscular  relaxation, 
in  the  case  of  certain  injuries,  as  in  fracture  or  dislocation  of  the 
jaw,  is  often  resorted  to  as  a  measure  against  spasmodic  con- 
traction, and  also  to  reduce  the  excessive  vascular  reaction. 

Cold^  when  outwardly  applied   as  a  depressor  to  the  inflamed 


INFLAMMATIOxX.  133 


part,  reduces  the  excitement  and  irritability.  The  application 
of  the  spray  of  absolute  ether,  or  of  rhigolene,  will  often  prove 
serviceable  in  the  early  stage  of  periodontitis.  Cold,  whenever 
moderately  applied,  is  tonic  and  invigorating,  and  besides  evapo- 
rating applications,  ice  may  be  employed  ;  but  such  local  meas- 
ures to  maintain  a  low  temperature  must  be  renewed  at  short  in- 
tervals. Cold,  when  locally  applied,  causes  the  capillaries  to 
contract,  thus  diminishing  the  afflux  of  blood  to  the  affected 
tissue.  The  persistent  application  of  cold,  however,  may  cause 
gangrene  ;  but  the  employment  of  the  ether  or  rhigolene  spray  is 
attended  with  less  danger  in  this  respect  than  that  of  ice  applica- 
tions. A  granulating  surface,  on  the  other  hand,  develops  better 
in  a  warm  temperature. 

Heat  and  Jk[oisture.—llea.t  is  also  under  certain  circumstances 
a  valuable  antiphlogistic.  Dry  heat  will  mitigate  pain,  and  heat 
with  moisture  in  the  form  of  a  poultice,  is  very  commonly  used 
to  relieve  the  pain  and  tensive  heat  of  local  inflammation  by  its 
soothing  and  relaxing  effect.  While  cold  has  an  astringent,  sedati\'e 
effect,  and  constringes  the  capillaries  of  the  inflamed  tissue,  thus 
promoting  healing  by  resolution,  moist  heat  is  relaxing  and  pro- 
motes exudation,  if  not  suppuration,  leading  to  repair  by  "the 
second  intention."  The  use  of  cold  is  dispensed  with  in  inflam- 
matory conditions  as  soon  as  it  is  apparent  that  the  termination 
of  the  inflammation  by  resolution  is  impossible,  when  resort  is 
had  to  poultices  or  warm  fomentations,  such  as  flaxseed  and 
slippery-elm  bark,  to  which  vaseline,  boracic  acid,  or  a  weak 
solution  of  carbolic  acid  may  be  added  to  prevent  fermentation 
in  the  poultice,  and  putrefaction  in  the  wound.  To  relieve  pain, 
tincture  of  opium  may  be  applied  to  the  surface  of  the  poultice,  a 
water-dressing  composed  of  cloth  saturated  with  warm  water,  or 
a  medicated  solution,  such  as  boracic  acid  or  biborate  of  sodium. 
The  local  warm  bath  is  also  another  method  of  applying  heat 
and  moisture,  as  the  granulations  of  a  surface  immersed  in  tepid 
water  develop  favorably ;  and  an  ulcerated  surface  which  has 
been  subjected  to  a  prolonged  warm  bath,  made  antiseptic  by 
carbolic  acid,  or  the  application  of  an  eight  per  cent,  solution  of 
chloride  of  zinc,  is  greatly  benefited.      Warmth  and  moisture  are 


134  DENTAL  MEDICINE. 


especially  indicated  for  parts  having  a  feeble  circulation.  Warm, 
moist  applications,  such  as  poultices,  promote  the  tendency  to 
suppuration ;  hence,  care  should  be  observed  in  applying  such 
applications  to  the  surface  of  the  face,  in  the  case  of  an  alveolar 
abscess,  as  pointing  and  the  escape  of  pus  may  be  induced  in  a 
position  where  permanent  disfigurement  would  be  very  apparent. 

Compression  is  also  of  service  in  the  treatment  of  certain  forms 
of  inflammation,  especially  during  the  late  stages;  but  it  must  be 
uniformly,  moderately,  and  continuously  applied.  Even  in  the 
acute  form,  compression  may  prevent  the  over-distention  of  the 
capillaries  and  limit  the  exudation;  in  the  chronic  form,  com- 
pression promotes  absorption.  It  is  accomplished  by  means  of 
bandages,  either  alone  or  in  conjunction  with  cotton  batting,  as 
the  latter  prevents  irregular  constriction  and  maintains  a  uniform 
temperature.  A  fine  compressed  sponge  moistened,  after  it  is 
applied,  with  tepid  water,  is  a  painless  and  effective  means  for 
obtaining  compression  in  the  treatment  of  indolent  ulcers.  Com- 
pression by  means  of  sheet  lead  or  tin,  and  pads  of  bibulous 
paper,  will  often  prevent  an  alveolar  abscess  from  discharging 
on  the  surface  of  the  cheek  or  neck,  when  such  an  event  is 
imminent. 

Blood-letting. — General  blood-letting  is  now  rarely  emploved  in 
the  treatment  of  inflammation  ;  but  the  local  abstraction  of  blood 
by  means  of  leeches,  cups,  scarification,  incisions,  and  other 
means,  is  of  great  service  in  reducing  vascular  action,  and  lessen- 
ing inflammatory  symptoms.  The  efliciency  of  local  depletion 
in  relieving  hyperaemia  is  very  evident  by  the  cessation  of  pain 
caused  by  strangulation  and  tension.  Periodontitis  and  acute 
gingivitis  furnish  examples.  Leeches  should  never  be  applied  to 
a  part  where  it  would  be  difficult  to  arrest  the  hemorrhage  which 
may  follow  their  use  ;  their  application  is  also  contra-indicated 
in  the  case  of  children,  who  cannot  bear  the  loss  of  considerable 
blood  with  impunity. 

Incisions  are  made  for  the  purpose  of  relieving  tension  and 
pain,  evacuating  pus,  or  the  escape  of  dead  material,  for  tension 
aggravates  the  inflammation  and  the  retention  of  pus  in  an 
abscess  prolongs  the   pain,  and   also  adds  to  the  destruction  of 


INFLAMMATION.  135 


parts  by  'the  formation  of  gangrenous  patches.  Superficial  in- 
cisions will  relieve  the  tension  of  the  skin  and  mucous  mem- 
brane, and  also  evacuate  the  pus  of  an  abscess  when  it  is  near  the 
surface. 

Deeper  incisions  are  necessary  when  the  pus  is  at  a  greater 
distance  from  the  surface,  and  there  is  considerable  tension.  In- 
cisions are  also  often  judicious  as  a  prevention  of  suppuration 
and  ulceration  ;  also  in  cases  where  the  presence  of  pus  is  sus- 
pected, but  there  is  no  apparent  fluctuation.  In  making  deep 
incisions,  care  is  necessary  to  avoid  wounding  arteries  and 
nerves;  hence  the  director  should  precede  the  use  of  the  knife. 
In  acute  abscesses  the  incisions  should  be  made  at  an  early  stage, 
and  of  such  a  size  as  will  permit  of  the  free  evacuation  of  the 
pus,  and  in  the  most  depending  position,  to  insure  its  easy  dis- 
charge. Hence,  as  soon  as  fluctuation  is  detected  in  an  acute 
abscess,  the  incision  for  the  escape  of  the  pus  should  be  made  ; 
while  in  the  case  of  a  chronic  or  cold  abscess,  the  incision  may 
be  delayed,  or  a  puncture  with  a  trocar  substituted  for  it,  which 
may  at  once  be  closed. 

Drainage  {or  Irrigation)  is  employed  for  the  purpose  of  giving 
outlet  for  any  matters  liable  to  collect  in  a  wound  or  abscess 
which  may  act  as  obstacles  to  the  process  of  repair.  Teeth  af- 
fected with  abscess  are  often  relieved  and  retained  by  an  opening 
made  into  the  pulp  canal  or  into  the  abscess  sac,  sufficiently  free 
to  relieve  the  tension  and  drain  off  the  accumulated  pus  ;  also  in 
the  case  of  abscess  of  the  antrum,  where  an  opening  made 
through  the  alveolar  cavity  of  one  of  the  roots  of  a  posterior  tooth 
is  kept  open  by  means  of  a  canula,  to  relieve  the  tension  and 
permit  the  pus  to  escape  as  it  accumulates,  and  also  to  afford  an 
easy  entrance  for  the  injection  of  antiseptic  and  stimulating  agents 
in  the  treatment  of  such  cases.  Drainage  can  also  be  made 
through  soft  tissues,  such  as  the  gum,  etc.,  by  strands  of  floss 
silk,  hemp  thread,  and  horse  hair,  dipped  in  a  carbolic  acid  solu- 
tion before  they  are  inserted  into  the  opening  connected  with  the 
sac  ;  also  by  means  of  caoutchouc  tubing. 

Counter  Irritation^  "counter  irritants,"  or  "derivatives,"  are 
also  employed  in  the  treatment  of  inflammation,  for  the  purpose 


136  DENTAL  MEDICINE. 


of  inducing  an  afflux  of  blood  from  the  locality  of  the  inflam- 
mation to  another  point  in  close  proximity,  thus  relieving  the 
vessels  of  the  affected  part.  Such  counter-excitement  in  the  case 
of  the  oral  mucous  membrane,  is  induced  by  blistering  applica- 
tions, stimulants,  escharotics,  etc.,  which  excite  a  new  action  in 
a  part  more  or  less  remote  from  the  focus  of  inflammation. 

Cantharidal  collodion,  tincture  of  iodine,  either  alone  or  in 
combination  with  aconite,  or  with  creasote,  or  with  carbolic  acid, 
nitrate  of  silver,  nitric  acid,  and  the  actual  cautery,  may  be 
named  as  the  most  common  counter-irritants  for  application  to 
the  oral  mucous  membrane  in  the  case  of  deep-seated  inflam- 
mation and  pulpitis,  and  are  mainly  useful  in  the  early  stage  of 
the  acute  form,  and  in  the  chronic  form. 

Antiseptic  and  Germicide  Mouth  Washes  and  Lotions^  such  as 
tincture  of  myrrh,  chlorate  of  potassa,  solutions  of  carbolic  acid, 
listerine,  permanganate  of  potash,  nitrate  of  silver,  sulphate  of 
copper,  sulphate  of  zinc,  lead  water,  tincture  of  opium,  aqueous 
solution  of  pyrozone,  bichloride  of  mercury  i  to  500,  i  to  1,000, 
I  to  2,000,  I  to  4,000.  Carbolic  acid  i  to  20,  i  to  40. 
Formalin  i  to  2,000.  Iodoform,  creolin,  peroxide  of  hydrogen, 
chloride  of  zinc,  boric  acid,  sulpho-carbolate  of  zinc  (which 
is  less  irritating  and  more  potent  than  the  chloride  of  zinc),  etc., 
are  employed  with  benefit  in  inflammations  and  ulcerations  of  the 
oral  mucous  membrane. 

When  putrefaction  is  present  in  the  inflamed  part,  chlorinous 
washes  are  serviceable  for  deodorizing  purposes,  and  also  to  pre- 
vent the  entrance  of  putrid  matter  into  the  circulation.  The 
object  of  cauterizing  an  inflamed  part  is  to  break  the  continuity 
of  the  morbid  process. 

Jnasthetics^  such  as  chloroform,  ether,  etc.,  when  employed  in 
the  treatment  of  inflammation,  exercise  an  influence  as  prevent- 
ives, and  also  render  lax  tissues  which  become  very  rigid,  and 
enable  reductions  to  be  made,  as  well  as  temporarily  mitigating 
the  pain  ;  fracture  and  dislocation  of  the  jaw  are  examples. 

When  inflammation  has  devitalized  parts,  the  treatment  varies 
in  respect  to  the  nature  of  such  parts.  Dead,  soft  tissues  are  to 
be  so  treated  that  the  putrid  matter  is  prevented  from  entering 


INFLAMMATION.  137 


the  circulation,  by  the  application  of  antiseptic  agents,  and  by 
maintaining  thorough  sterilization;  hence,  antiseptics  which  pos- 
sess the  power  of  destroying  micro-organisms  without  the  dan- 
ger of  destroying  the  vitality  of  the  tissues,  are  considered  to  be 
the  most  active  agents  of  this  class.  When  the  hard  tissues  are 
devitalized,  such  as  bone,  for  example,  although  the  living  bone 
becomes  separate  from  the  dead  portion  as  efFectuallv  as  a  living 
soft  part  from  its  slough,  yet  it  is  necessary  to  liberate  the  bony 
sequestrum  from  the  overlying  texture  which  may  confine  it; 
hence  the  removal  of  dead  bone  is  necessary  as  soon  as  the  line 
of  demarcation  is  formed,  the  time  for  which  may  vary  from  a 
period  of  less  than  three  weeks  in  the  case  of  small  sequestra, 
to  more  than  two  months,  where  the  entire  bone  is  involved. 
Also  in  cases  where  the  extremity  of  a  part  consisting  of  soft 
and  hard  tissues,  for  example,  the  alveolar  process  and  tissues 
over  it,  become  gangrenous,  it  is  best,  in  most  instances,  to  re- 
move the  dead  tissues  by  amputation  ;  and  such  an  operation  may 
also  become  necessary  in  cases  of  long-continued  exhaustive  sup- 
puration. A4any  forms  of  inflammation  have  their  special 
remedies,  such  as  mercurial  inflammation  of  the  mouth,  when 
chlorate  of  potash  is  indicated  ;  periodontitis,  when  tincture  of 
iodine  and  tincture  of  aconite,  or  creasote,  or  carbolic  acid,  in 
combination  with  the  iodine,  or  iodine,  aconite,  canabis  indica, 
and  benzoin  in  combination,  etc.,  are  indicated ;  gingivitis, 
where  stimulating  and  antiseptic  washes  and  lotions  of  tincture 
of  myrrh,  biborate  of  soda,  boric  acid,  carbolic  acid  solutions 
and  combinations,  etc.,  are  indicated.  The  spray  of  liquid  air 
is  useful  in  aborting  periodontitis,  alveolar  abscess,  also  in  ad- 
vanced stages  of  abscess  after  incision,  in  all  inflammatory  and 
ulcerated  conditions  of  the  oral  mucous  membrane,  etc.  (See 
Liquid  Air.) 

Constitutional  Treatment. — Cathartics  are  serviceable  for  remov- 
ing the  unwholesome  ingesta  and  irritating  fecal  accumulations 
from  the  stomach  and  bowels,  and  also  for  stimulating  the  secre- 
tions of  the  gastric  and  intestinal  glands,  the  liver,  pancreas, 
etc.,  they  also  eliminate  through  such  organs  the  toxic  elements 
introduced  into  the  blood;  also,  by  their  revulsive  action,  reduc- 


138  DENTAL  MEDICINE. 


ing  or  withdrawing  nervous  action  from  the  inflamed  part. 
Diuretics  and  diaphoretics  are  useful  for  promoting  elimination 
of  toxic  substances  through  the  kidneys.  Diffusible  stimulants 
are  useful  for  heart  failure,  such  as  brandy,  whiskey,  and  cognac. 
The  temperature  can  be  reduced  by  sponging  the  surface  of  the 
body  with  tepid  water,  or  by  the  use  of  the  warm  bath. 

Diet. — The  diet  is  of  great  importance  in  all  forms  of  inflam- 
mation. Food  of  the  most  nutritious  character  and  of  a  form 
easily  digested  is  very  necessary.  Milk,  pure,  or  mixed  with  lime 
water,  peptonized  or  sterilized,  or  in  the  form  of  gruel,  is  the 
most  valuable  of  all  liquid  foods ;  alcohol  may  be  given  with 
it  in  the  form  of  wine  whey.  Meat  broths  are  nutritious  and 
digestible,  and  pure  beef  juice  is  very  reliable.  When  food  can- 
not be  taken  by  the  stomach,  enemata  of  beef  broths,  and  some 
of  the  various  peptonized  forms  of  meat,  may  be  given  by  the 
rectum.  A  few  drops  of  laudanum  with  the  enema  will  assist 
in  retaining  food  thus  given.  After  the  fever  and  inflammation 
subside,  the  solid  forms  of  food  may  be  given  more  freely. 
Tonics,  such  as  iron,  calisaya  bark  and  the  phosphites,  are  then 
indicated  to  improve  the  appetite  and  favor  repair. 

Ulceration  is  a  passive  process,  and  results  from  the  molec- 
ular death  caused  by  insufficient  blood  supply,  insufficient  nerv- 
ous influence,  impure  quality  of  blood,  or  the  presence  of  blood 
poison.  Ulceration  is  very  closely  associated  with  inflamma- 
tion, although  the  former  may  be  independent  of  the  latter,  and 
consists  of  a  progressive  softening  and  disintegration  of  successive 
layers  of  the  affected  tissue.  Ulceration  generally  begins  in  a 
process  of  chronic  inflammation,  and  in  such  a  manner  that  the 
death  of  the  tissues  only  occurs  when  the  tissues  themselves  have 
undergone  cellular  infiltration  in  consequence  of  the  inflamma- 
tory changes.  The  loss  of  the  integument  leaves  a  red,  raw 
surface,  which  bleeds  ea-sily,  and  which  is  covered  with  a  tena- 
cious, slimy  matter.  Very  soon  irregular  cavities  are  formed  in 
this  surface,  separated  by  red  elevations  with  ragged  edges.  A 
thin,  serous,  bloody  discharge  exudes,  with  severe  pain  of  a 
gnawing  character.  The  ulcer  then  formed,  and  which  has 
been  defined  as  "  a  wound  surface  having  no  tendency  to  heal," 


INFLAMMATION.  139 


or  an  "open  sore,"  spreads  more  or  less  rapidly,  and  the  sur- 
rounding integument  is  hot  and  swollen,  and  the  disintegrated 
tissue  is  thrown  off  as  extraneous  matter.  It  originates  from  an 
excess  in  action  of  the  retrograde  changes  over  such  as  induce 
repair.  Ulcers  also  originate  from  pustules  that  fail  to  heal  after 
the  pus  escapes,  but  spread  and  maintain  an  acute  inflammatory 
character.  An  ulcer  may  be  circular,  crescentic,  irregular,  in 
the  form  of  a  shallow  or  deep  ring,  or  it  may  be  tubular,  forming 
a  fistula. 

The  edges  of  an  ulcer  are  either  low  or  raised,  hard  (callous), 
soft,  jagged,  vertical,  everted,  or  undermined,  etc.  Ulcers  aris- 
ing from  persistent  local  irritation,  as  those  of  the  oral  mucous 
membrane,  usually  heal  as  soon  as  the  affected  parts  are  placed 
under  favorable  external  circumstances.  As  long  as  the  epi- 
thelium is  preserved,  the  superficial  inflammatory  process  in 
mucous  membranes  may  be  called  catarrh.  When  suppuration 
of  mucous  membranes  proceeds  so  far  as  to  expose  the  substantia 
propria  or  corium,  the  diseased  surface  is  known  as  an  ulcer. 
The  surface  of  an  ulcer  is  covered  with  coarse  granulations  of  a 
dark  red  color,  while  healthy  granulations  are  cherry  red  in  color. 
The  ulcer  granulations  bleed  readily.  Age,  sex,  and  occupation, 
are  important  factors  in  the  etrology  of  ulcers,  as  age  is  charac- 
terized by  diminished  physical  power  and  vital  resistance,  and 
retrogressive  tissue  changes.  Ulcers  are  three  times  as  prevalent 
among  men  as  among  women :  they  are  also  more  prevalent 
among  the  laboring  classes,  owing  to  a  greater  degree  of  ex- 
posure to  injuries,  and  also  to  a  greater  neglect  of  personal  clean- 
liness. Ulcers  are  classified  accordino-  to  their  origin,  such  as 
the  non-infectious  and  the  infectious.  The  non-infectious  com- 
prise those  caused  by  friction,  pressure,  or  other  mechanical 
injuries,  chemical  irritation,  enervation,  impaired  nutrition,  and 
obstructed  local  circulation. 

Ulcers  are  also  classified  as  inflamed,  irritable,  fungous,  hem- 
orrhagic, torpid,  callous,  corroding,  perforating,  phagedenic,  and 
malignant.  An  inflamed  ulcer  is  characterized  by  swollen  edges, 
surrounding  skin  very  tender,  dense  and  shining,  and  the  base  and 
surrounding  parts  more  or  less  acutely  inflamed.     The  irritable 


140  DENTAL  MEDICINE. 


ulcer  is  characterized  by  abrupt  edges  showing  no  tendency  to 
cicatrize,  and  extreme  tenderness  or  sensitiveness.  The  fun- 
gous ulcer  is  characterized  by  an  exuberant  growth  of  granula- 
tions. The  hemorrhagic  ulcer  is  characterized  by  a  tendency  to 
bleeding  upon  the  least  provocation,  and  is  common  to  scurvy. 
Torpid  ulcers  are  those  which  manifest  no  disposition  of  activity 
in  any  direction.  Callous  ulcers  are  characterized  by  a  dirty, 
granulating  surface  covered  with  thin,  muco-purulent  pus,  and 
prominent  edges.  Corroding  ulcers  are  destructive,  progressively, 
of  soft  tissues,  beginning  as  a  cutaneous  disease,  which  becomes 
a  boil  and  afterward  an  ulcer.  Perforating  or  round  ulcers  are 
peculiar  to  the  stomach,  and  caused  by  local  obstruction  of  its 
blood  vessels.  Phagedenic  ulcers  spread  rapidly,  with  great  local 
irritation,  and  loss  of  tissue.  Malignant  ulcers  are  characterized 
by  a  rapid,  spreading  course,  with  perforation  of  soft  parts,  and 
resulting  in  gangrene  and  sloughing,  and  necrosis  of  bone. 

The  process  of  healing  in  ulcers  is  brought  about  by  granula- 
tion and  cicatrization,  the  devitalized  parts  separating  from  the 
living  parts  in  the  form  of  a  thin,  ichorous  discharge,  the  exu- 
dates beneath  and  about  the  walls  of  the  ulcer  becoming  vas- 
cularized and  loops  of  capillary  vessels  forming  and  growing 
toward  the  surface.  Numbers  of  leucocytes  cluster  around  these 
capillary  loops,  and  thus  a  healthy  surface  is  formed  which  dis- 
charges a  creamy  pus-laudable  pus. 

Cicatrization  is  a  process  of  skin-growth  which  covers  over 
the  new  granulation  tissue,  the  surrounding  surface  of  skin  or 
membrane  sinking  to  a  level  with  the  granulations  and  the  edge 
of  the  ulcer  undergoing  change  in  consistence  and  color,  and  the 
epithelial  cells  undergoing  segmentation,  and  growing  toward  the 
centre  of  the  ulcer,  which  is  indicated  by  a  blue  film.  At  the 
same  time  the  ulcer  is  contracting,  and  continues  for  a  consid- 
erable period,  and  often  causes  great  deformity. 

The  cicatrix  is  different  from  the  original  substance,  having 
neither  nerves,  glands,  lymphatics,  nor  hair,  and  when  injured  is 
prone  to  ulcerate. 

The  causes  of  ulceration  are  divided  into  predisposing  and 
exciting,  local   and  constitutional.     The  predisposing  causes  are 


INFLAMMATION.  141 


changes  in  nutrition,  peculiar  dyscrasiae,  and  diatheses,  the  rapid- 
ity of  the  circulation,  and  injuries  which  are  the  most  frequent 
causes,  especially  in  the  aged,  the  feeble,  and  those  suffering  from 
some  constitutional  diathesis,  such  as  tuberculosis,  syphilis,  gout, 
diabetes,  etc.  Common  ulcers  are  of  the  mucous  membrane  and 
skin  and  are  never  fatal  except  through  septic  infection. 

Treatment. — The  treatment  of  ulcers  is  both  local  and  consti- 
tutional, the  cause  of  irritation  being  first  removed  and  the  inflam- 
matory symptoms  relieved.  Rest  of  the  affected  part,  cleanliness, 
hot  antiseptic  applications,  elevation  of  limb  when  an  extremity 
is  involved.  Stimulating  remedies  such  as  nitrate  of  silver,  per- 
manganate of  potash,  sulphate  of  copper,  iodine,  boric  acid, 
balsam  of  Peru,  and  ichthyol,  especially  in  indolent  ulcers,  and 
spraying  with  liquid  air,  are  excellent.  Chromic  acid  is  useful 
in  secondary  syphilitic  ulcers.  Iodine  and  iodoform  are  service- 
able in  tubercular  ulcers.  Skin-grafting  and  plastic  flap  opera- 
tions are  sometimes  resorted  to  for  the  purpose  of  closing  ex- 
tensive ulcers ;  also  sponge-grafting  to  hasten  the  process  of 
healing.  The  constitutional  treatment  of  ulcers  is  directed  to 
the  systemic  condition,  when  it  is  a  predisposing  cause,  and 
appropriate  remedies  administered  for  its  eradication.  The 
strength  must  be  supported  by  the  use  of  tonics,  and  a  vegetable 
diet  recommended,  and  also  abstinence  from  wine  and  malt  liquors, 
etc. 

Gangrene. — Gangrene  signifies  the  mortification  or  death  of 
a  part  of  the  body,  owing  to  failure  in  nutrition,  and  death  of 
soft  tissue.  There  are  two  forms  of  gangrene — the  dry  or 
senile,  and  the  moist.  Dry  gangrene — mummification — occurs 
from  death  of  the  soft  tissue  of  parts  exposed  to  the  air,  and 
results  from  defective  blood-supply  owing  to  feebleness  of  the 
circulation  and  changes  in  the  vessels.  The  diseased  part  be- 
comes engorged  with  blood,  and  the  coloring  matter  transudes 
the  tissues,  and  the  part  assumes  a  dark  red  or  purple  appearance. 
The  tissues  begin  to  dry  from  evaporation,  and  the  affected  part 
becomes  leathery,  hard,  and  brittle,  and  also  black ;  between  the 
dead  and  sound  tissues  there  is  an  inflammatory  zone,  or  line  of 
demarkation.     Usually  there  are  no  general  constitutional  symp- 


142  DENTAL  MEDICINE, 


toms.  Moist  gangrene  is  a  form  of  the  disease  where  the  death 
of  the  soft  tissue  is  followed  by  decomposition  and  putrefaction, 
the  result  of  the  presence  of  micro-organisms  entering  either 
through  the  air  or  the  circulation.  The  decomposed  tissue  has 
the  characteristic  odor  of  putrid  animal  matter,  disintegrating  and 
liquefying.  Gases  form,  causing  puffiness  of  the  part,  pressure 
on  which  causes  crepitation.  The  symptoms  of  moist  gangrene 
are  those  of  acute  inflammation,  great  congestion  and  an  intense 
burning  pain.  The  constitutional  symptoms  are  a  low  type  of 
inflammatory  fever,  rapid  feeble  pulse,  and  low  delirium. 

A  frequent  cause  of  gangrene  is  inflammation  of  the  walls  of 
the  arteries  (arteritis),  which  results  in  the  formation  of  new  tissue 
within  the  walls  of  the  vessels,  and  obstructs  the  flow  of  the  blood. 

Treatment. — The  treatment  of  gangrene  consists  in  efforts  to 
remove  the  primary  cause,  support  the  strength  by  a  generous  diet, 
and  use  of  stimulants.  Digitalis  is  indicated  in  case  of  a  feeble 
heart,  and  bitter  tonics  to  improve  the  appetite.  When  gangrene 
attacks  the  face  and  mouth,  the  dead  tissue  should  be  removed 
as  soon  as  the  line  of  demarkation  is  established,  and  the  wound 
treated  on  antiseptic  principles.  Boric  acid  solution  and  Thiersch 
solution  are  valuable  antiseptics  for  use  in  the  oral  cavity. 

Necrosis. — Necrosis  signifies  the  death  of  bone-tissue,  and 
corresponds  to  gangrene  of  soft  parts.  The  degree  of  injury, 
traumatic  or  idiopathic,  which  is  required  to  cause  necrosis,  is 
much  less  than  that  necessary  to  cause  death  of  the  soft  tissues. 
This  is  due  to  the  fact  that  the  external  (superficial)  layers  of 
bone  receive  their  supply  of  blood  from  numerous  small  vessels 
given  off  from  the  periosteum,  and  the  separation  of  the  perios- 
teum from  the  bone,  which  sometimes  occurs  from  the  pus  of 
an  alveolar  abscess  making  its  way  between  the  bone  and  the 
periosteum,  deprives  the  external  layer  of  bone  of  its  blood- 
supply  and  causes  necrosis.  The  occurrence  of  stasis  resulting 
from  the  Haversian  vessels  of  bone  becoming  obstructed  owing 
to  the  presence  of  inflammatory  stimulus  which  demands  a  larger 
blood-current  and  more  blood-cells,  and  which  these  vessels  can- 
not supply,  on  account  of  their  inability  to  enlarge,  is  another 
reason  for  the  susceptibility  of  bone  to  necrosis. 


INFLAMMATION.  143 


The  devitalized  portion  of  bone  is  called  a  "  sequestrum," 
and  the  devitalized  soft  tissue  is  called  a  "  slough."  Necrosis 
may  involve  a  small  portion  of  a  bone,  or  it  may  affect  the  entire 
bone. 

The  dead  portion  of  bone  becomes  detached  from  the  living 
tissues  by  the  formation  of  granulation  tissue  between  the  de- 
vitalized and  living  portions,  and  finally  the  disintegration  of  this 
tissue  separates  the  dead  portion.  Pus  is  always  present,  and 
around  the  necrosed  bone,  there  is  an  accumulation  of  a  fetid, 
purulent  fluid,  which  contains  broken-down  tissue  and  debris  re- 
sulting from  decomposition  as  well  as  from  the  inflammatory 
process ;  the  purulent  fluid  penetrates  the  tissues  and  reaches  the 
surface. 

The  necrosed  portion  is  lighter  than  living  bone,  on  account 
of  the  organic  portion  having  been  removed  by  decomposition 
and  the  action  of  the  granulation  tissues. 

Necrosis  of  bone  is  caused  by  impaired  or  arrested  blood- 
supply,  which  may  result  from  injury,  inflammatory  conditions 
induced  by  mercurial  ptyalism,  syphilis,  phosphorous  poisoning, 
extensive  inflammation  of  neighboring  parts,  or  any  cause  which 
impairs  the  vitality  of  the  tissues.  Fractures  and  inflammation 
of  the  periosteum  (periostitis)  are  the  most  frequent  causes  of 
necrosis. 

Necrosis  of  the  jaws  is  much  more  common  to  the  lower  than 
to  the  upper  jaw,  which  is,  no  doubt,  owing  to  the  greater 
nutrition  of  the  upper  jaw  which  not  only  renders  it  less  liable 
to  injury  resulting  in  periostitis,  but  also  increases  its  recupera- 
tive powers.  The  toxic  forms  of  necrosis  are  due  mainly  to 
mercury,  phosphorus,  and  arsenic. 

The  form  known  as  "  phosphor-necrosis  "  due  to  the  vapor 
of  phosphorus  coming  in  contact  with  the  periosteum  and  pro- 
ducing periostitis,  and  which  may  occur  on  exposure  to  such 
fumes  after  the  extraction  of  teeth,  manifests  itself  almost  en- 
tirely in  the  lower  jaw. 

Phosphorus-necrosis  commences  as  inflammation  of  the  peri- 
osteum with  the  production  of  osteophytes,  and  results  in  nearly 
total  necrosis  of  the  entire  bone. 


14:4  DENTAL  MEDICINE. 


Necrosis  of  the  jaws  may  be  either  partial  or  complete — 
partial  when  it  is  confined  to  the  aveolar  process,  complete  when 
the  entire  thickness  of  the  bone  is  affected.  The  causes  are  the 
same  as  those  of  periostitis,  such  as  injuries,  eruptive  fevers, 
syphilis,  periodontitis,  scorbutus,  mercurial,  phosphorus,  and 
arsenical  poisoning,  and  ulceration  of  the  soft  tissues.  The 
svmptoms  of  necrosis  are  in  the  beginning  the  same  as  those  of 
periostitis  or  periodontitis,  and  after  the  disease  is  established,  the 
pus  escapes  by  the  side  of  the  loosened  teeth  and  the  gums  be- 
come detached  from  the  bone,  and  pus  finds  an  outlet  from  be- 
tween them.  In  necrosis  of  the  lower  jaw  the  pus  frequently 
penetrates  the  tissues  covering  the  bone  and  points  upon  the  under 
surface  of  the  jaw  ;  at  other  times  the  pus  may  follow  the  inter- 
muscular connective  tissue  of  the  neck,  and  point  as  low  down 
as  the  clavicle  or  breast.  The  necrosis  may  also  extend  to  bones 
of  the  face  and  head.  The  necrosed  portion  of  bone  becomes  a 
foreign  body  which  the  surrounding  tissues  endeavor  to  extrude, 
or  to  wall  off  and  surround,  owing  to  the  presence  of  granula- 
tion tissue,  which  gradually  perforates  the  surrounding  bone  at 
places  of  least  resistance,  the  result  being  the  formation  of  one 
or  more  sinuses,  through  which  the  dead  portion  can  be  with- 
drawn with  little  trouble.  Separation  finally  takes  place  between 
the  living  and  dead  portions  of  the  bone.  While  this  is  taking 
place,  a  quantity  of  new  bone,  especially  in  the  case  of  necrosis 
of  the  lower  jaw,  is  forming  around  the  sequestrum  ;  the  new 
osseous  tissue  is  called  the  "  involucrum,"  which  it  is  necessary 
to  at  least  partially  remove  before  the  sequestrum  can  be  with- 
drawn. 

Treatment. — The  treatment  of  necrosis  of  bone  consists  in  the 
removal  of  the  dead  portion  (sequestrum),  and  the  restoration  of 
the  parts  to  a  condition  favoring  regeneration.  The  removal 
of  the  sequestrum  or  dead  portion  is  accomplished  with  bone- 
forceps  and  chisels,  and  all  the  lining  material  of  the  cavities 
which  the  fragments  have  occupied  should  be  scraped  away  with 
a  sharp  spoon.  The  cavities  are  then  packed  with  iodoform 
gauze  soaked  in  a  mixture  of  balsam  of  Peru,  containing  ten  per 
cent,    of   guiacol.      Before    the    sequestrum    or    dead    fragments 


IXFLAMMATIOX.  I45 


separate  from  the  living  bone,  no  attempt  should  be  made  to 
remove  them,  but  the  suppurating  surfaces  should  be  frequently 
irrigated  with  antiseptic  solutions.  The  fetid  odor  of  the  breath 
may  be  corrected  by  freely  using  a  solution  of  permanganate  of 
potassium  and  cinnamon  :  also  the  fetid  odor  of  the  discharges. 
The  treatment  of  phosphorus-necrosis  and  other  toxic  forms, 
consists  in  the  use  of  antiseptic  solutions,  the  opening  of 
abscesses,  and  the  removal  of  diseased  bone,  and  especially  of 
dead  bone  upon  the  first  provocation.  The  constitutional  treat- 
ment in  all  forms  of  necrosis  should  be  supporting,  and  liquid 
foods  given  where  there  is  inability  to  open  the  mouth.  Such 
tonics  as  iron,  quinine,  cod-liver  oil,  malt  extracts  are  indicated, 
together  with  change  of  air. 

Caries  of  Bone. — Caries  affecting  bone  is  a  chronic  inflamma- 
tion, with  rarefaction  or  absorption  of  bone-tissue  attended  by 
suppuration  ;  it  is  molecular  death  of  bone,  being  a  disintegration 
of  the  tissue.  Both  necrosis  and  caries  of  bone  bear  the  same 
relation  to  the  osseous  tissue,  that  gangrene  and  ulceration  do  to 
the  soft  tissues.  When  percussion  is  made  a  different  sound  is 
distinguished  between  necrosis  and  caries  of  bone,  owing  to  the 
difference  in  the  degree  of  density.  The  probe  reveals  a  sharp 
sound  in  the  case  of  necrosed  bone,  owing  to  its  hardness,  while 
the  use  of  this  instrument  reveals  a  dull  sound  in  the  case  of 
caries  of  bone,  and  the  probe  also  penetrates  the  diseased  structure. 

The  causes  of  caries  of  bone  depend  upon  a  chronic  inflamma- 
tory condition  generally  due  to  tubercular  or  syphilitic  infection. 
Among  the  bones  most  frequently  attacked  are  the  bones  of  the 
face,  and  the  lower  jaw,  especially  the  latter.  The  syphilitic 
form  most  commonly  affects  the  bones  of  the  nose  and  palate. 
When  carious  bone  is  exposed,  it  is  found  to  be  softened  and 
disintegrated,  and  portions  have  been  removed  by  liquefaction  or 
absorption,  leaving  a  greater  or  less  cavity,  the  surface  of  which  is 
covered  with  granulations  and  pus.  Among  the  granulations  may 
be  found  small  spiculas  of  dead  bone,  surrounded  by  pus.  In 
caries  of  bone  resulting  from  syphilis,  ulceration  destroys  the 
external  surface  of  the  bone,  leaving  a  granulating  surface,  dis- 
charging the  gummy  pus. 
10 


146  DENTAL  MEDICINE. 


Treatment. — The  treatment  of  caries  of  bone  consists  in  re- 
moving the  carious  portion  with  the  bone-chisel  and  sharp  spoon 
and  disinfecting  the  entire  tract  with  hydrogen  peroxide  or  caustic 
pyrozone,  then  packing  the  wound  with  iodoform  gauze,  soaked 
in  a  mixture  of  balsam  of  Peru  containing  ten  per  cent,  of  guiacol. 
The  constitutional  treatment  consists  in  the  giving  of  tonics, 
such  as  iron,  quinine,  cod-liver  oil,  and  malt  extracts,  and  nourish- 
ing food. 

General  Remarks. — In  every  case,  the  first  object  should  be  to 
ascertain  and,  if  possible,  remove  the  cause  of  a  disease.  It 
should  be  remembered  that  medicinal  substances  are  always  more 
certain  in  their  action  when  applied  directly  to  the  affected 
tissue  j  also,  that  chemical,  physical  and  vital  changes  result  from 
the  topical  action  of  such  substances ;  and  that  age  modifies  the 
effects,  and  also  determines  the  dose ;  also  sex^  owing  to  the 
greater  susceptibility  of  the  nervous  system  in  females  than  in 
males;  also  the  temperament^  as  the  sanguine,  for  example,  is 
more  susceptible  to  the  influence  of  medicinal  agents  than  the 
phlegmatic ;  also  habit  and  tnode  of  life.,  as  the  habitual  use  of 
such  agents  as  stimulants  lessens  their  influence,  and  the  occupa- 
tion affects  the  susceptibility  to  external  influence  ;  also  the  con- 
dition of  the  body.,  as  different  diseases  exercise  considerable  in- 
fluence on  the  effects  of  medicinal  substances ;  also  the  mind.,  as 
a  hopeful  mind  conduces  to  the  beneficial  action  of  medicines ; 
also  idiosyncrasy.,  as  some  individuals  are  more  susceptible  to  the 
action  or  effects  of  medicinal  substances  than  others  ;  also  the 
nature  of  the  tissue  or  organ  to  which  application  is  made,  as  some 
are  more  susceptible  to  the  effect  of  medicinal  agents  than  others, 
owing  to  rapidity  of  absorption  and  the  degree  of  decomposition 
of  the  substance  employed  ;  also  climate.,  from  the  recognized  in- 
fluence of  climate  in  modifying  the  structure  and  functions  of  the 
animal  economy,  and  increasing  or  diminishing  morbid  conditions, 
and  by  such  means  influencing  the  effects  of  medicinal-agents. 

In  most  acute  diseases  there  is  a  tendency  to  recovery  after  a 
certain  time  has  elapsed,  in  case  there  is  no  failure  in  the  func- 
tions of  any  of  the  essential  organs;  hence,  in  all  acute  diseases, 
the  state  of  the  nervous  system  should  be  carefully  watched. 


INFLAMMATION.  147 


When  the  affection  is  not  of  a  serious  character,  such  symp- 
toms as  are  especially  troublesome  may  be  relieved  ;  but  when 
the  nervous  and  vascular  systems  are  affected,  both  locally  and 
generally,  then  it  is  necessary  that  the  proper  measures  for  their 
relief  be  promptly  taken. 

Where  mucous  membrane  is  the  seat  of  the  affection,  it  is  often 
possible  to  remove  the  exciting  cause.  There  are  also  many  in- 
flammatory affections  met  with,  where,  from  the  beginning,  there 
is  a  diminished  action  of  the  heart,  and  a  depressed  state  of  the 
nervous  centres.  In  the  treatment  of  such  cases,  the  depressed 
condition  of  the  general  system  chiefly  requires  attention,  as  the 
progress  and  termination  of  the  local  affection  depend  upon  the 
cause  from  which  it  has  originated. 

There  are  also  morbid  states  not  necessarily  dependent  on 
organic  disease.  Various  acids  are  produced  by  the  fermentation 
of  substances  containing  starch  or  sugar,  and  there  is  reason  for 
believing  that  an  increased  secretion  of  acid  may  take  place  from 
the  mucous  membrane  of  the  stomach  and  produce  symptoms 
of  acidity  independently  of  fermentation,  although  one  of  the 
properties  of  the  gastric  fluid  is  to  prevent  fermentation.  The 
symptoms  of  acidity  are  a  sour  taste,  and  the  occurrence  of  acid 
eructations,  often  accompanied  with  heartburn,  and  sometimes 
with  diarrhoea,  and  a  feeling  of  sinking  at  the  epigastrium. 

In  these  cases  the  causes  must  be  sought  for,  and  such  treat- 
ment instituted  as  will  neutralize  the  acidity  and  stimulate  the 
peptic  glands  to  an  increased  secretion  of  the  digestive  fluid ; 
also  such  as  will  regulate  the  bowels.  Due  attention  must  also 
be  given  to  the  diet,  which  should  consist  of  such  substances  as 
will  not  readily  ferment,  and  all  food  containing  starch  should  be 
avoided. 

Although  topical  remedies  are  more  generally  employed  in  the 
treatment  of  dental  affections,  yet  there  are  many  diseases  of  the 
oral  cavity  which  are  due  to  remote  causes  and  require  constitu- 
tional as  well  as  local  treatment. 

The  appearances  presented  by  the  mucous  membrane  of  the 
mouth  are  valuable,  as  indicating  the  state  of  other  parts  more 
remote  J  and  it  is  frequently  the  case  that,  when  the  constitutional 


148  DENTAL  MEDICINE. 


affection  is  overcome,  the  local  symptoms  disappear  as  a  conse- 
quence, or  become  very  amenable  to  local  remedies. 

IMPORTANT  POINTS  IN  DIAGNOSING  AFFECTIONS  OF  THE 
MOUTH,  WITH  A  SYNOPSIS   OF  TREATMENT. 

The  Irritation  of  Teething  is  indicated  by  a  hot,  swollen  and 
tender  condition  of  the  gums,  fretfulness,  irritable  temper,  refusal 
of  nourishment,  fever  and  thirst,  and,  if  not  relieved,  diarrhoea 
with  offensive  motions,  sometimes  a  troublesome  cough,  convul- 
sions, and  other  serious  results. 

An  Abnormal  Dentition  is  indicated  by  a  hot,  drv  mouth, 
swollen  gums,  tense,  tender  and  shining,  fever,  disordered  bowels, 
fretfulness,  eruption  on  skin,  diarrhoea,  convulsions. 

Convulsions  of  Dentition  are  indicated  by  such  premonitory 
symptoms  as  irritable  temper,  unusual  brightness  of  eyes,  indis- 
position to  eat  or  sleep,  slight  involuntary  movements  of  muscles 
of  face,  or  extremities,  grinding  of  teeth.  The  paroxysm  is  in- 
dicated by  rigidity  of  body,  utterance  of  a  cry,  face  turning  red 
or  purple,  veins  of  neck  turgid,  suspension  of  respiration,  loss 
of  consciousness,  irregular  and  intermittent  contractions  of 
muscles,  protrusion  of  tongue,  frothing  at  lips,  distortion  of  face, 
rolling  of  eyeballs,  contracted  and  rapid  pulse. 

Treatment. — For  the  relief  of  the  premonitory  symptoms  of 
dentition,  bromide  of  potassium  in  doses  of  gr.  iij  to  v,  accord- 
ing to  age,  every  ten  minutes.  Demulcent  and  soothing  lotions 
to  the  gums.  An  aperient  if  no  diarrhoea  is  present.  For  more 
decided  symptoms,  scarification  or  lancing  of  the  gums.  An 
enema  of  soap  and  water  to  relieve  the  digestive  canal  of  irrita- 
ting substances,  or  the  use  of  the  following  combination  to  abate 
the  fever  and  allay  the  irritability  of  stomach  and  bowels : — 

R .     Potass,  bromidi  pulv gr-  xv 

Potass,  nit.  pulv gr-  xij 

Zinci  oxidi      gr.  ij  M. 

Divide  in  chart.  No.  vi. 
SiG. — One  powder  every  four  hours,    until  bedtime. 

For  the  diarrhoea :   change  the  diet,  adopt  hygienic  measures ; 


DIAGNOSIS   OF   MOUTH   AFFECTIONS.  I49 

mild  purgatives  in  small  doses.  For  acid  dejections,  calcined 
magnesia  ;  or  small  doses  of  sulphate  of  magnesia  and  tincture  of 
rhubarb  ;  or  of  pulv.  ipecac,  pulv.  rhubarb  and  bicarbonate  of  soda  ; 
or  castor  oil  in  doses  of  5ss.  For  infancy  diarrhoeas  Dr.  Thomas 
claims  excellent  results  from  the  following  mixtures  in  gastric  or 
gastro-intestinal  dyspepsia,  characterized  by  nausea,  vomiting, 
flatulence  and  diarrhoea  with  non-slimy,  fetid,  yellowish  or  green- 
ish stools.  ]^.  Lactic  acid,  oj-  simple  syrup,  ov  ;  water, 
oiijss.  M.  Sig. — One  drachm  every  quarter  to  half  hour  after 
meals.  (See  Dr.  James  W.  White's  recipes  under  opium, 
chloroform,  aromatic  sulphuric  acid  and  bromide  of  potassium.) 

For  convulsions:  the  administration  of  an  anaesthetic  to  abort 
or*  control  the  spasmodic  movements  ;  hydrate  of  chloral,  gr.  v  to 
X,  according  to  age,  dissolved  in  two  or  three  drachms  of  water, 
and  injected  into  the  rectum  ;  or  the  administration  of  bromide 
of  potassium;  use  of  hot  foot  bath,  to  which  is  added  a  small 
quantity  of  mustard  ;  the  warm  bath  ;  and  when  cerebral  conges- 
tion is  threatened,  cold  applications  to  the  head. 

According  to  Dr.  A.  Brothers:  i.  Dentition  is  rarely,  if  ever, 
a  direct  cause  of  death. 

2.  Precocious  or  retarded  dentition  may  occur  in  otherwise 
healthy  children  or  in  entire  families. 

3.  The  period  of  eruption  of  the  first  teeth  occurs,  in  healthy, 
breast-fed  children,  at  six  and  a  half  months  in  the  vast  majority 
of  cases,  and  first  dentition  is  usually  complete  at  thirty  months. 

4.  Dentition  is  distinctly  retarded  in  the  first  as  well  as  the 
later  teeth  in  children  brought  up  on  a  mixed  or  artificial  diet. 

5.  Congenital  diseases — tuberculosis,  syphilis,  endocarditis — 
seem  to  have  a  retarding  influence  on  dentition. 

6.  Rachitis  has  a  very  pronounced  retarding  influence  on  the 
whole  course  of  dentition. 

7.  Scrofulosis  seems  to  hasten  the  eruption  of  the  first  teeth, 
but  does  not  affect  the  later  teeth, 

8.  In  cases  of  undeveloped  brain — idiocy — there  is  a  marked 
retardation  during  the  entire  period  of  dentition. 

9.  Chronic  diseases  have  a  retarding  power  over  the  first  teeth, 
but  do  not  seem  to  influence  the  later  teeth. 


150  DENTAL  MEDICINE. 


10.  Children  suffering  from  marasmus  seem  to  be  precocious 
with  the  first  teeth,  but  delayed  with  the  later  teeth. 

11.  Cases  of  epilepsy,  developing  in  early  infancy,  seem  to 
have  their  first  teeth  appear  early. 

Hemorrhage  after  Extraction. — Remove  loose  clot,  wash  out 
cavity  with  hot  water;  then  plug  cavity  with  iodoform  gauze; 
or,  cotton  dipped  in  mastic,  and  rolled  in  tannin  ;  or,  cotton  sat- 
urated with  oil  of  turpentine,  or  perchloride  of  iron  ;  or,  ferric 
alum  ;  or,  cotton  saturated  with  phenol  sodique,  and  then  dipped 
in  tannic  acid ;  or,  antipyrine  on  cotton.  Internally  :  Adminis- 
ter three  grains  of  tannic  acid  dissolved  in  two-thirds  of  a  tum- 
bler of  water,  of  which  two  teaspoonfuls  are  given  every  five 
minutes  until  three  doses  have  been  taken,  after  which  give  fhe 
same  quantity  every  fifteen  minutes.  Gallic  acid,  ergot,  or  oil 
of  turpentine,  may  also  be  given  internally,  especially  when  the 
hemorrhage  is  indicative  of  some  constitutional  vice.  In  addi- 
tion, upright  posture,  and  a  cool  apartment. 

For  After-pains  of  Tooth  Extraction. — A  single  drop  of  nitro- 
glycerine, one  per  cent,  solution,  in  half  a  glass  of  cold  water. 
The  careful  inhalation  of  one  or  two  drops  of  amyl-nitrite  for 
three  or  four  seconds,  followed  by  complete  rest  for  five  minutes, 
is  also  recommended.  Also,  locally,  Fletcher's  carbolized  resin, 
composed  of  resin,  carbolic  acid,  and  chloroform,  which  is  a  good 
styptic  also;  or,  chloroform  one  part,  and  tincture  of  pyrethrum 
three  parts. 

Pericementitis^  or  Periodontitis^  or  Inflammation  of  the  Peridental 
Membrane  is  indicated  by  a  sense  of  uneasiness  and  fullness, 
which  is  at  first  relieved  by  pressure,  but,  after  active  inflamma- 
tion is  established,  pressure  on  the  affected  tooth  causes  intense 
pain,  of  a  dull,  heavy,  annoying  character.  The  tooth  is  also 
protruded,  to  a  slight  degree,  from  the  alveolus,  and  also  some- 
what loosened,  owing  to  the  thickening  of  the  investing  mem- 
brane ;  and  the  inflammation,  which  is  at  first  manifested  by  a 
red  line  near  the  margin  of  the  gum,  becomes  general  over  the 
entire  root,  sometimes  involving  the  neighboring  gum,  and  even 
the  palate  and  cheek,  and  symptoms  of  febrile  disturbance.  In 
extreme  cases  the  temperature  may  rise  to  105°  F.,  and  subse- 


DIAGNOSIS   OF   MOUTH    AFFECTIONS.  151 

quently  septicemia,  or  pyemia  and  death  may  ensue.  If  not  ar- 
rested, a  suppurative  condition,  alveolar  abscess,  ensues.  A 
modification  of  the  symptoms  just  enumerated,  the  tooth  being 
tender  to  pressure,  more  or  less  raised  in  its  cavity,  and  sur- 
rounded by  a  reddened  and  swollen  gum,  with  a  varying  amount 
of  pain,  and  the  discharge  of  pus  from  around  the  neck  of  tooth, 
or  from  a  fistulous  opening  in  the  gum,  and  such  symptoms  con- 
tinuing for  a  long  time,  indicate  the  chronic  form  of  an  ad- 
vanced state  of  periodontitis,  which  often  results  from  systemic 
influences.  The  common  cause  of  severe  cases  of  pericementitis 
is  the  entrance  of  pyogenic  organisms  from  the  pulp-canals  of 
teeth  into  the  tissues  of  the  apical  space  and  into  the  lymphatics. 
Treatment. — Remove  all  irritants;  apply  counter-irritants,  such 
as  equal  parts  of  tinct.  iodine,  tinct.  aconite,  tincture  of  canabis 
indica,  and  compound  tincture  of  benzoin  ;  or  cantharidal  collo- 
dion; or  iodine  and  creasote,  or  carbolic  acid;  or  capsicum  in 
form  of  tincture,  or  in  srnall  bags  of  the  powder  to  surface  of 
gum  over  root  of  affected  tooth.  Depletion  by  the  lancet, 
leeches  or  cups.  Hypodermic  injection  of  morphine,  or  tinct. 
of  opium.  Application  of  spray  of  rhigolene  or  absolute  ether 
until  gum  is  blanched.  To  relieve  pain,  a  solution  of  equal 
parts  of  tinct.  aconite,  tinct.  of  opium,  and  chloroform ;  or  lead 
water  and  tinct.  opium.  Disinfecting  the  root  canals,  after  the 
removal  of  a  decomposed  or  dead  pulp,  by  means  of  disinfectants 
and  antiseptics,  viz.  :  peroxide  of  hydrogen,  or  pyrozone,  in 
three,  or  five  per  cent,  solutions  or  fifty  per  cent,  solution  of 
peroxide  of  sodium,  used  alternately  ;  also,  by  the  cataphoric 
current  with  solutions  possessing  the  requisite  conductivity,  such 
as  a  saturated  solution  of  iodide  of  potassium  to  which  is  added 
about  one  fifth  its  quantity  of  a  mixture  of  equal  parts  of  the 
tinctures  of  iodine  and  aconite.  Constitutional  treatment :  Saline 
cathartics  ;  bromide  of  potassium,  gr,  xxv,  combined  with  gtt.  v 
of  tinct.  veratrum,  every  four  hours  ;  or  bromide  of  potassium 
alone,  in  doses  of  gr.  xxv  or  xxx  ;  or  hot  water  applications  to 
face  and  neck,  and  calcium  sulphide  in  yV  gr.  pill  until  eight  have 
been  taken  in  two  hours,  then  one  every  half-hour  for  two  hours; 
or,  drachm  doses  of  fluid  extract  of  gelsemium,  minims  x,  water 


152  DENTAL  MEDICINE. 


5j,  every  fifteen  minutes  until  four  doses  have  been  taken,  then 
every  half-hour  for  two  hours.  Sulphate  of  quinine  gr,  viij  com- 
bined with  sulphate  of  morphia  gr.  y^  and  patient  placed  in  bed 
with  the  head  elevated.  If  pulse  is  full  and  throbbing,  tincture 
of  aconite  ten  drops  in  one  ounce  of  water,  and  teaspoon ful  doses 
given  every  hour  until  the  pulse  becomes  normal.  If  the  inflam- 
matory symptoms  are  not  relieved  in  five  hours,  the  feet  are  to  be 
placed  in  hot  water,  and  then  wrapped  in  blankets,  and  x  gr.  of 
Dover's  powder  in  hot  lemonade  given  until  free  diaphoresis 
occurs.  The  tooth  protected  from  irritation  during  treatment, 
by  a  cap  over  adjoining  teeth.  The  removal  of  the  extremity  of 
the  root  of  a  tooth  affected  with  chronic  periodontitis  by  means 
of  a  trepan,  has  also  been  suggested. 

Jlveolar  Abscess  is  first  indicated  by  pain  of  a  constant  char- 
acter, which  is  afterwards  aggravated  at  each  pulsation ;  then 
swelling  about  the  roots  of  the  affected  tooth,  which  at  length 
becomes  defined  and  prominent,  and  afterwards  points  and  dis- 
charges pus,  when  the  active  symptoms  subside.  The  develop- 
ment of  alveolar  abscess  is  indicated  by  such  constitutional  symp- 
toms as  foul  tongue,  offensive  breath,  hot  skin,  thirst  and  head- 
ache, and  when  the  suppuration  is  considerable,  symptomatic 
fever  and  rigors. 

The  characteristic  pain  of  an  alveolar  abscess  is  deep-seated 
and  throbbing,  and,  with  the  swelling,  denotes  the  formation  of 
pus.  J  chronic  form  of  alveolar  abscess  is  indicated  by  a  subsi- 
dence of  the  active  symptoms,  and  a  continuance  of  the  discharge 
of  small  quantities  of  pus  through  a  fistulous  opening  opposite 
the  root  of  the  affected  tooth,  or  about  its  neck.  An  elastic 
fluctuating  swelling  in  any  part  of  the  face,  or  for  some  distance 
down  the  neck,  may  result  from  abscessed  teeth. 

Treatment. — Remove  all  irritants.  Give  free  vent  for  the 
escape  of  the  pus.  Destroy  sac  of  abscess  by  therapeutic  treat- 
ment, or  by  a  surgical  operation.  Therapeutic  treatment :  First 
cleanse  the  root-canal  by  injections  of  chloride  of  sodium  on  per- 
oxide of  hydrogen,  or  pyrozone,  or  peroxide  of  sodium  ;  escha- 
rotics  to  destroy  the  sac,  such  as  creasote,  carbolic  acid,  salicylic 
acid,  nitrate  of  silver,  iodine,  dilute  aromatic  sulphuric  acid,  to 


DIAGNOSIS   OF   MOUTH    AFFECTIONS.  I53 

which,  in  chronic  cases,  add  tinct.  of  capsicum  ;  also  antiseptics  : 
bichloride  of  mercury,  chloroform  and  aristol,  also  oil  of  cassia 
and  oil  of  gaultheria,  in  combination  with  carbolic  acid,  kalium- 
natrium.  Sodium  peroxide  twenty-five  to  fifty  per  cent,  solution, 
or  pyrozone  twenty-five  per  cent,  ethereal  solution,  may  be  em- 
ployed to  secure  the  thorough  sterilization  of  the  dentine  of  the 
root,  followed  by  powerful  antiseptics,  such  as  Black's  i,  2,  3 
mixture ;  the  pulp-cavity  may  first  be  washed  out  with  the  three 
per  cent,  solution  of  pyrozone  by  means  of  a  syringe  and  dried, 
when  the  fifty  per  cent,  solution  of  sodium  peroxide  is  worked  into 
the  canals  with  a  fine  smooth  platinum  broach,  and  a  continuation, 
after  drying  the  cavity,  of  the  application  of  the  sodium  peroxide, 
until  the  saponifying  action  ceases.  The  surgical  method  con- 
sists in  gaining  access  to  the  sac,  by  means  of  a  bistoury  or  small 
trephine,  through  the  fistulous  opening,  where  such  exists,  and 
detaching  and  breaking  up  the  sac  by  means  of  suitable  nerve  in- 
struments and  the  application  of  escharotic  agents.  Liquid  air 
applied  intermittently  in  the  form  of  spray,  has  been  successfully 
used  as  a  local  anaesthetic  in  opening  abscesses.  Dr.  Brophy, 
speaking  of  cases  of  alveolar  abscess  where  the  disease  is  in  the 
bone,  says  :  "  In  such  cases  if  the  treatment  is  simply  opening 
into  the  tooth  for  drainage  with  the  expectation  that  nature  will 
effect  a  cure,  we  will  be  disappointed.  In  such  cases  an  incision 
should  be  made  down  to  the  diseased  bone,  packing  it  with  iodo- 
form gauze,  or  boracic  acid  gauze.  The  next  day  with  a  bur 
cut  off  the  affected  portion  of  the  roots  of  the  teeth  because  they 
are  a  source  of  irritation ;  then  with  a  bud-bur  pass  over  the 
bone,  and  remove  the  dead  portions,  and  again  pack  the  wound 
with  antiseptic  gauze.  In  a  day  or  two  make  an  examination, 
and  if  healthy  granulations  are  beginning,  insert  a  wax  plug, 
which  is  not  permeable  like  the  gauze,  to  prevent  the  wound 
from  closing,  and  the  consequent  trouble  from  confined  pus." 

Alveolar  Abscess  about  to  point  Externally  is  indicated  by  the  skin, 
for  some  distance  around  the  central  point,  becoming  red  and  dis- 
tended, with  a  throbbing  sensation,  succeeded  by  a  change  in  the 
appearance  of  the  skin  to  a  thin  and  scaly  surface,  from  which 
the  epidermis  scales  off.     The  integument  becomes  glued  down 


154  DENTAL  MEDICINE. 


to  the  bone  around  the  spot  where  the  pus  will  ultimately  appear; 
the  latter  following  a  fistulous  track  between  the  diseased  tooth 
and  the  surface  of  the  cheek,  the  fistula  remaining  open  and  dis- 
charging as  long  as  the  inflammatory  action  continues. 

Treatment. — Make  a  free  incision  in  the  gum  opposite  and 
near  the  apex  of  the  root  of  the  affected  tooth.  Apply  to  the 
surface  of  the  threatened  point  of  exit  of  the  pus,  alcohol,  or 
spirits  of  camphor,  or  paint  with  collodion,  and  make  gentle  pres- 
sure by  means  of  a  compress  of  sheet  lead  or  sheet  tin,  or  pads 
and  bandage,  to  change  the  direction  of  the  pus. 

Suppuration  or  Abscess  of  the  Antrum  is  indicated  by  a  discharge 
of  pus  into  the  nose,  sometimes  producing  scarcely  any  discomfort ; 
at  other  times  the  severest  local  and  constitutional  suffering  ;  an 
aching  pain  in  the  cheek,  which  is  hot,  flushed,  and  somewhat 
swollen ;  also  in  forehead  and,  as  the  symptoms  increase,  greater 
pain,  of  a  throbbing  character,  with  the  rigors  and  fever  peculiar 
to  suppuration  ;  an  expansion  of  the  bone  of  the  upper  jaw ;  an 
elevation  of  the  malar  bone,  with  a  very  apparent  depression  be- 
neath it ;  the  molar  teeth  on  the  affected  side  depressed  so  as  to 
appear  elongated,  and  to  prevent  the  proper  closure  of  the  mouth  ; 
an  increase  of  pus ;  the  palate  losing  its  concavity  and  becoming 
convex ;  the  nostril  of  the  affected  side  being  encroached  upon, 
and,  in  protracted  cases,  the  floor  of  the  orbit  of  the  eye  so  pushed 
up  as  to  force  the  eye  partly  from  its  socket;  the  sight  affected 
by  the  stretching  of  the  optic  nerve;  the  walls  of  the  antrum  be- 
coming so  thin  as  to  afford  evidence  of  fluid-fluctuation  on  pres- 
sure, and  crepitus;  at  length  the  pus  escaping  through  the  cheek, 
or  into  the  nose,  or  burrowing  along  the  side  of  a  root  of  a  tooth 
and  discharging  into  the  mouth  ;  the  floor  of  the  orbit  giving 
way  and  the  pus  discharging  along  the  lower  eyelid. 

Treatment. — Make  an  opening  into  the  antrum,  either  through 
the  alveolar  cavity  of  one  of  the  roots  of  a  superior  first  or  second 
molar,  or  through  the  process  between  the  roots  of  the  first 
and  second  molars,  which  is  the  most  dependent  portion  of  the 
antral  cavity,  with  a  suitable  trephine,  and  thoroughly  wash  out 
the  cavity  with  a  warm  injection  of  salt  5j  to  water  Oss,  and  if 
there  is  an  offensive  odor,  syringe  with  a  solution  of  permangan- 


DIAGNOSIS   OF   MOUTH   AFFECTIONS.  155 

ate  of  potash ;  then  dress  daily  with  a  solution  composed  of 
carbolic  acid  one  part,  and  oil  of  sweet  almonds  fifteen  parts, 
applied  on  cotton  secured  in  the  cavity.  If  no  improvement, 
then  syringe  the  antrum  with  a  solution  consisting  of  carbolic 
acid  oji  tinct.  iodine,  .5),  iodide  of  potassium  gr.  xv,  water  i^viij. 
Where  a  more  powerful  stimulant  is  required,  use  an  injection  of 
zinc,  gr.  x  to  the  ounce  of  water.  For  systemic  treatment,  ad- 
minister sulphide  of  calcium  in  the  form  of  one-tenth  of  a  grain 
pill  three  times  a  day  after  meals,  doubling  the  dose  if  necessary. 
[Dr.  Frank  Jbbott.)  When  an  opening  has  been  made  into  the 
antrum,  sufficiently  large  to  admit  the  little  finger,  the  following 
treatment  has  proved  effectual;  syringe  first  with  a  warm  solution 
of  chloride  of  sodium,  after  which  inject  diluted  peroxide  of 
hydrogen,  increasing  the  strength  of  the  solution  gradually  if 
necessary,  until  the  pus  has  ceased  discharging;  after  this  a  solu- 
tion of  boric  acid  or  listerine  may  be  used.  The  injection  of 
peroxide  of  hydrogen  into  the  antrum  through  a  small  opening  is 
not  justifiable  owing  to  its  effervescent  action  on  the  pus.  Dr.  F. 
D.  Weisse  recommends  injecting  the  antrum  at  least  five  times  a 
day  with  a  solution  of  hyposulphite  of  soda,  one  drachm  to  one 
ounce  of  water.  Dr.  J.  S.  Marshall  recommends  as  a  wash  for 
the  antrum,  boracic  acid  twelve  parts,  salicylic  acid  four  parts, 
water  one-thousand  parts ;  iodoform,  iodol,  aristol,  pyoktanin, 
sulphonal  and  boric  acid,  in  form  of  powder,  are  also  recom- 
mended. M.  Emile  Denis  recommends  syringing  out  the  cavity 
twice  a  day  with  a  sixteen  per  cent,  solution  of  boricine  (see 
boricine),  and  then  applying  about  ateaspoonful  of  the  powdered 
boricine. 

Alveolar  Ulceration  is  distinguished  from  alveolar  abscess  by  the 
presence  of  an  ulcerated  surface  of  peridental  membrane  instead 
of  pus  contained  in  a  fibrous  sac,  the  purulent  matter  in  alveolar 
ulceration  oozing  out  through  the  gum  or  around  the  neck  of  the 
affected  tooth  :  no  new  tissue  is  formed,  as  in  the  case  of  abscess  ; 
but  the  normal  tissue  is  disorganized  and  wasted,  and  the  matter 
discharged  is  watery,  translucent,  and  may  be  in  some  cases  odor- 
less, while  that  from  an  abscess  is  thick,  opaque  and  offensive. 
Ulceration   causes   little   or  no  swelling,  and  the  inflammation  is 


156  DENTAL  MEDICINE. 

phagedenic  in  character,  destroying  hard  and  soft  tissues  by 
chemical  decomposition.  Like  alveolar  abscess,  it  may  be  due 
to  the  death  of  the  pulp,  and  it  may  begin  as  abscess,  not  being  a 
primary  disease,  but  always  preceded  by  some  other  well-estab- 
lished and  usually  chronic  affection.  In  alveolar  ulceration  a 
considerable  portion  of  the  peridental  membrane  is  destroyed,  and 
there  is  a  wasting  away  of  the  alveolus  and  cementum  in  the 
region  of  the  ulcer,  whereas  in  alveolar  abscess  the  peridental 
membrane  may  remain  in  an  inflamed  and  morbid  condition  and 
the  alveolar  walls  firm  and  penetrated  at  one.  point  to  permit  of 
the  escape  of  the  pus.  In  long-continued  alveolar  ulceration,  as 
a  result  of  the  disease,  calcareous  deposits,  in  the  form  of  gran- 
ules, collect  on  the  root  from  the  ulcerated  area  to  the  margin  of 
the  gum. 

The  treatment  consists  in  the  thorough  removal  of  the  calcic 
deposit  when  present,  and  the  scraping  of  the  root  of  the  tooth 
over  the  entire  ulcerated  surface,  and  the  application  of  antiseptic 
and  astringent  remedies,  such  as  listerine,  aromatic  sulphuric 
acid,  etc. 

Maxillary  Abscess  may  be  due  to  caries  or  the  diseases  of  the 
teeth,  or  to  pathological  changes  occurring  in  the  structure  of  the 
bone  itself. 

Treatment. — The  treatment  of  maxillary  abscess  consists  either 
in  puncture  or  incision,  and  the  extraction  of  one  or  more  of  the 
teeth  if  they  are  found  to  be  connected  with  the  origin  of  the 
disease.  If  free  drainage  be  established  by  an  early  incision,  the 
arrest  of  the  disease  is  practically  secured  :  it  is  sometimes  neces- 
sary to  remove  a  portion  of  the  alveolar  process.  The  presence 
of  dead  bone  should  be  determined,  and  such  removed,  with  other 
offending  matter.  Free  drainage  should  be  maintained  until  com-  « 
plete  recovery  is  brought  about.  The  abscess  may  be  opened 
under  cocaine  anaesthesia,  a  soft  rubber  drainage  tube  be  inserted, 
and  the  cavity  thoroughly  irrigated  and  disinfected  with  a  I  to 
2,000  bichloride  of  mercury  solution.  A  safety  pin  may  be 
placed  at  the  external  end  of  the  tube,  and  a  strip  of  iodoform 
gauze  put  between  it  and  the  skin  ;  over  this  the  ordinary  bi- 
chloride gauze  dressing  may  be  secured  by  a  roller  bandage. 


DIAGNOSIS   OF   MOUTH   AFFECTIONS.  I57 

Arsenical  Necrosis  of  the  Alveolar  Process  is  indicated  by  a  dark 
purple  and  swollen  condition  of  gum,  with  offensive  purulent  dis- 
charge from  one  or  more  fistulous  openings,  or  from  between 
the  gums  and  the  teeth.  The  gum  becomes  soft  and  spongy, 
very  sensitive,  bleeds  readily,  and  loses  its  connection  with  the 
necrosed  bone  beneath. 

Treatment. — (See  Necrosis  of  the  Jaws.) 

Phosphor-Necrosis  is  indicated  by  pain  in  jaw,  similar  to  odon- 
talgia, at  first  not  constant,  but  soon  becoming  severe,  and  ex- 
tending alongside  of  the  head,  and  to  the  shoulder,  with  swelling 
and  great  tenderness  near  the  seat  of  the  affection,  the  integument 
becoming  red  and  tense,  the  teeth  elongated  and  extremely  pain- 
ful when  closed  together,  and  also  becoming  loose;  the  gums 
and  mucous  membrane  of  the  cheeks  swollen  and  livid ;  at 
length,  suppuration  ensues,  with  fever,  rigors,  etc. ;  gums  become 
spongy,  with  escape  of  pus  around  necks  of  necrosed  teeth,  and 
the  pus  fetid,  and  the  swelling  very  great,  especially  when  the 
lower  jaw  is  affected  ;  a  dense  plastic  exudation  encases  the  under 
and  external  surface  of  the  bone  ;  intense  glistening  redness  of 
the  skin,  as  the  pus  approaches  the  surface ;  at  length,  intense 
fever,  with  delirium  and  great  suffering;  the  throwing  out  of  a 
bony  deposit  of  a  peculiar  appearance,  like  pumice-stone. 

Treatment. — Removal  of*  patient  from  exposure  to  fumes  of 
phosphorus,  and  the  excision  of  diseased  portions  of  bone ;  the 
subsequent  treatment  being  that  for  Necrosis  of  Bone. 

Fracture  of  the  Alveolar  Process  is  indicated  by  a  swollen,  red 
and  painful  state  of  gum  and  tissues  covering  maxillary  bone,  oc- 
curring some  days  after  the  receipt  of  the  injurv,  and,  if 
neglected,  may  result  in  necrosis  of  the  body  of  the  bone. 

Treatment. — Antiphlogistic  lotions,  to  reduce  the  inflammation, 
such  as  — 

R.     Plunibi  acetatis ^] 

Tinct.  opii ^ss 

Aquae ^  viij  or  x.     M. 

SiG. — Apply  on  lint. 

Remove  any  detached  portions  of  process,  and  secure  loose 
teeth  with  waxed  sterilized  ligatures. 


158  DENTAL  MEDICINE. 


Mercurial  Poisonings  or  Salivation^  when  of  a  mild  form,  is  in- 
dicated by  a  red  margin  of  the  gum,  which  eventually  becomes 
somewhat  spongy  and  tender,  with  a  slight  fetor  of  the  breath 
and  a  metallic  taste. 

An  increased  degree  of  salivation,  or  tnercurial  stomatitis^  is  in- 
dicated by  a  profuse  flow  of  saliva,  intense  fetor,  strong  metallic 
taste,  tenderness  of  the  gums,  stiffness  of  the  jaws,  followed  by 
ulceration  and  sloughing,  if  the  injudicious  use  of  the  mercury  is 
persisted  in. 

Treatment. — Discontinue  use  of  mercury.  Chlorate  of  potash, 
internally,  gr.  x,  in  water  .^ss :  as  a  gargle,  5jj  to  water  oj  >  oi' 
iodide  of  potassium  in  doses  of  gr.  iij,  three  times  a  day.  To 
correct  fetor  of  breath,  permanganate  of  potash  solution,  gr.  ij  to 
X,  to  the  ounce  of  water ;  or  washes  of  chlorinated  soda;  astrin- 
gent washes  during  convalescence.  Loose  teeth  should  not  be 
removed,  as  they  will  again  become  firm. 

Lead  Poisoning  is  indicated  by  a  blue  line  upon  the  edge  of  the 
gums,  and  such  constitutional  symptoms  as  paralysis  and  colic 
attend  severe  cases. 

Treatment. — Administration  of  iodide  of  potassium  in  gr.  iij 
doses  four  times  a  day,  after  meals,  to  eliminate  the  lead ;  saline 
cathartics,  electricity,  strychine,  etc.,  for  the  paralysis,  and  tonics, 
such  as  quinine,  to  promote  the  strength. 

Scurvy  is  indicated  by  a  general  spongy  condition  of  the  gums, 
and,  in  severe  cases,  intense  fetor,  ulceration  and  sloughing  to- 
gether with  constitutional  symptoms  of  an  aggravated  character. 
The  premonitory  symptoms  in  the  mouth  are,  gums,  paler  than 
usual,  with  a  slight  tumid  or  everted  line  on  free  margins,  and  a 
slight  tenderness  on  pressure ;  breath  offensive,  and  a  disagree- 
able taste ;  tongue  flabby  and  larger,  though  clean  and  pale. 
Later,  the  gums  become  darkened  in  color,  inflamed,  swollen, 
spongy,  bleed  readily,  and  finally  separate  from  the  teeth.  The 
gums  of  edentulous  jaws  do  not  present  these  symptoms.  At 
length,  the  gums  present  great,  fungous,  lacerable  excrescences, 
which  are  prone  to  suppurate  and  become  a  brown,  fetid  mass, 
with  a  very  offensive  odor.  The  salivary  glands  become  en- 
larged and  swollen ;  tongue  indented  by  the  teeth,  which  latter 


DIAGNOSIS   OF   MOUTH    AFFECTIONS.  I59 

become  coated  with  a  salivary  deposit,  and  finally  drop  out. 
Necrosis  and  extensive  exfoliation  of  the  bones  of  the  jaw  may 
occur.  Some  varieties  of  salivary  calculus  will  produce  similar 
local  symptoms,  especially  when  the  general  condition  of  the 
system  is  unfavorable. 

Treatment. — Change  of  diet,  substituting  fresh  meats,  soups, 
nitrogenous  food,  and  recent  vegetable  acids,  lemon-juice,  lime 
juice,  citric,  tartaric,  and  acetic,  and  these  combined  with  potas- 
sium. Nitrate  of  potassium,  either  alone  or  mixed  with  vinegar, 
as  an  anti-scorbutic.  Arsenic  and  iron  are  of  service  in  most 
cases  J  also  rest  and  quiet. 

J  Simple  Form  of  Stomatitis  is  indicated  by  slightly  elevated, 
reddish,  glistening  patches  on  the  mucous  membrane,  which  may 
coalesce,  so  that  the  whole  surface  is  involved. 

Treatment. — Emollient  and  detergent  lotions,  such  as  slippery- 
elm  bark,  pith  of  sassafras,  or  borax,  5j,  glycerine,  ,5j,  or,  borax, 
5j,  honey,  5iiji  or  a  weak  solution  of  alum,  or  acetate  of  lead, 
gr.  iij  to  the  ounce  of  water.  A  kw  doses  of  bromide  of  potas- 
sium will  relieve  the  nervous  excitement.  Chlorate  of  potash 
lotion,  gr.  v  to  the  ounce  of  water,  is  also  efficacious  as  a  local 
remedy.  This  affection  usually  subsides  as  soon  as  the  consti- 
tutional disorder  is  relieved.  A  mild  cathartic  and  attention  to 
the  diet  may  be  all  that  is  required. 

Suppurative  Gingivitis. — Dr.  Ottolengui  recommends  for  this 
affection  spraying  the  gingivae  with  a  three  per  cent,  solution  of 
pyrozone ;  then  remove  all  deposits  thoroughly ;  for  virulent 
cases  he  employs  a  five  per  cent,  solution,  and  sometimes  a 
twenty-five  per  cent,  solution.  Pain  following  the  application 
of  the  pyrozone  may  be  relieved  by  applying  glycerole  of  tannin. 
This  treatment  is  to  be  resorted  to  twice  a  week,  using  the  three 
per  cent,  solution  of  pyrozone  as  a  mouth-wash  during  this  time. 
Where  sensitiveness  about  necks  of  teeth  or  elsewhere  is  caused 
by  the  one-twentieth  of  one  per  cent,  of  acidity  of  the  pyrozone, 
it  may  be  neutralized  by  placing  a  small  particle  of  carbonate  of 
magnesia  in  the  tumbler,  and  then  pouring  in  the  three  per  cent, 
solution  of  pyrozone  to  be  used. 

Catarrhal  Stomatitis  is  indicated  bv  undue  redness  and  capillary 


160  DENTAL  MEDICINE. 

conjestion  of  the  mucous  membrane,  with  engorgement  and 
swelling  of  the  mucous  follicles,  swelling  of  the  tongue,  gums, 
cheeks,  and  lips,  fetor  of  breath,  heat  and  dryness  of  mouth,  and 
in  some  cases  this  is  followed  by  excessive  secretion  of  saliva  and 
mucus,  when  the  gums  often  become  soft  and  spongy,  and  bleed 
easily.  Vesicles  sometimes  appear  on  the  tongue,  lips,  and 
cheeks,  which  leave  minute  ulcers,  with  a  yellowish  centre,  and 
red  margin.  Fissures  may  form  at  angles  of  mouth,  and  upon 
the  lips,  with  exudation  and  the  formation  of  crusts ;  but  the 
pain  is  not  generally  severe.  The  constitutional  symptoms  are 
fever,  diarrhoea,  thirst,  loss  of  both  appetite  and  sleep. 

Treatment. — Correcting  the  gastro-intestinal  derangement  by 
castor  oil,  rhubarb,  or  rhubarb  combined  with  carbonate  of  soda ; 
attention  to  the  milk,  the  use  of  a  mild  antiseptic  solution  as  a 
mouth-wash,  chlorate  of  potash  solution,  or  a  weak  solution  of  sul- 
phate of  zinc  or  copper.  Lime  water  added  to  the  milk,  and  a  hy- 
gienic condition  maintained.     The  following  is  very  serviceable  : 

R.     Pottassii  chlorat 7^'] 

Tinct.  myrrh gtt.  xx 

Elixir  calisayse f.  ^iij.     M. 

SiG. — Internally,  a  teaspoonful  in  water  every  four  hours. 

Locally  : 

B .     Sodii  boratis gr.  xxx 

Mel.  purificati f-  3"J 

Aquae  q.  s.  ad f-  5  "J-     M. 

SiG. — To  be  used  as  a  mouth-wash  every  four  hours,  or  on  a  swab. 

Peroxide  of  hydrogen  ,5j  water  eight  ounces,  is  also  valuable  as 
a  mouth-wash. 

Ulcerous  Stomatitis^  common  to  childhood,  is  indicated  by 
ulceration  commencing  on  or  near  the  gums,  more  frequently  in 
the  lower  than  in  the  upper  jaw,  and  usually  on  one  side  only, 
and  spreading  over  the  entire  mouth.  The  gum  first  becomes 
thickened  and  congested,  and  of  a  deep  purple  color,  and  bleeds 
readily  ;  ulceration  speedily  occurs,  and  exposes  the  necks  of  the 
teeth,  and  extends  to  the  mucous  membrane  of  the  mouth  gen- 
erally, the  ulcerated  surface  being  covered  with  a  dirty  white  or 
yellow  exudation,  leaving  exposed  numerous  bright  red  points  on 


DIAGNOSIS   OF   MOUTH   AFFECTIONS,  161 

a  yellowish  ground.  The  edges  of  the  ulcers  are  sharp  and 
ragged,  and  the  ulcer,  at  first  superficial,  becomes  gradually 
deeper.  Ulcers  of  the  mouth  are  often  due  to  syphilis  and  dys- 
pepsia, and  are  aggravated  by  the  irritation  resulting  from  the 
irregular  edges  of  fractured  and  decayed  teeth.  When  neglected, 
such  ulcers  may  assume  the  appearanct  of  epithelioma,  especially 
when  induration  of  the  glands  beneath  the  jaw  is  present. 

Treatment. — Remove  all  apparent  causes  of  irritation  by  cor- 
recting the  bad  condition  of  health.  Change  diet  and  residence, 
if  at  fault,  observe  cleanliness,  administer  stimulants  and  tonics, 
as  liquor  ferri  nitratis  with  tincture  of  calumba,  etc.  Local  ap- 
plications of  nitrate  of  silver,  gr.  j  to  iij  to  the  ounce  of  water,  or 
diluted  muriatic  acid,  alternating  with  a  lotion  of  equal  parts  of 
borax  and  honey,  or  chloride  of  lime,  5j,  honey  5j  j  also,  pyrozone 
three  per  cent,  europhen  combined  with  lanolin,  phenosalyl,  gly- 
cozone,  etc.  Chlorate  of  potash  internally,  in  doses  of  o'j  or  iij, 
and  also  as  a  lotion,  is  efficacious ;  also,  a  strong  solution  of 
borax,  in  obstinate  cases,  gr.  xv  to  the  ounce  of  water ;  also,  a 
solution  of  sulphate  of  copper;  painting  the  ulcers  with  tincture 
of  iron  and  glycerole  is  also  beneficial. 

Ulcers  of  the  Mouth  due  to  Syphilis  are  indicated  when  such 
ulceration  is  obstinate  under  any  but  specific  treatment,  and 
when  accompanied  by  symptoms  peculiar  to  syphilis. 

Treatment. — Constitutional  treatment  with  mercury  or  iodide 
of  potassium,  and  such  local  remedies  as  are  employed  in  ulcer- 
ous stomatitis. 

Syphilitic  Inflammation  of  the  Mucous  Membrane  of  the  Mouth  is 
indicated  by  a  general  swelling  of  the  gums,  with  everted  and 
ulcerated  margins,  exposing  the  necks  of  the  teeth,  although  not 
affecting,  to  any  great  degree,  their  stability,  with  a  viscid  dis- 
charge, mixed  with  blood,  from  about  their  necks ;  soreness 
rendering  mastication  painful ;  the  affection  slowly  spreading 
until  the  bone  is  exposed  and  a  portion  exfoliated ;  greater 
degree  of  congestion ;  formation  of  mucous  patches  on  sides 
of  cheeks ;  superficial  ulcers  inside  of  cheeks  and  beneath  the 
tongue  ;  erosions  of  the  soft  palate  and  tonsils  ;  fissures  at  cor- 
ner of  the  mouth  and  eruptions  on  skin  and  scalp. 
11 


162  DENTAL  MEDICINE. 


Treatment. — (See  Ulcers  of  the  Mouth  due  to  Syphilis.) 

Gangrenous  Stomatitis^  common  to  children  during  the  shedding 
of  the  temporary  teeth,  is  indicated  by  a  thick  swelling  of  the 
face ;  skin  tense  and  shining ;  swelling  becoming  hard  and  cir- 
cumscribed, but  devoid  of  tenderness,  with  a  central  spot,  red 
and  variegated  in  appearance ;  the  formation  of  an  ulcer,  corre- 
sponding to  the  red  spot  outside,  on  the  inside  of  the  cheek; 
profuse  salivation,  the  ulcerated  part  becoming  gangrenous,  with 
an  opening  through  the  cheek;  absence  of  pain  and  destruction 
of  parts. 

Treatment. — Preventive  :  Pure  air,  cleanliness,  nourishing  diet, 
sulphate  of  quinine,  internally,  in  doses  of  gr.  ij  to  iij  ;  and  as  a 
lotion,  sulphate  of  zinc,  5j  to  the  ounce  of  water.  When  the 
disease  is  established,  the  local  use  of  escharotics — as  acetic,  sul- 
phuric, nitric,  hydrochloric  acids,  nitrate  of  silver,  acid  nitrate 
of  mercury,  or  chloride  of  antimony — each  applied  by  means  of 
a  camel-hair  brush  to  gangrenous  part,  and  at  once  followed  by 
the  application  of  dry  chloride  of  lime.  The  mouth  to  be 
washed  out  with  tepid  water,  by  means  of  a  syringe.  After 
the  separation  of  the  slough,  the  dry  chloride  of  lime  alone  may 
be  used.  The  muriated  tincture  of  iron  is  also  employed  ;  and 
after  the  gangrene  is  arrested,  astringent  and  antiseptic  lotions  are 
efficacious. 

Scrofula. — In  early  life  the  characteristics  are  most  apparent. 
Tendency  to  enlargement  of  lymphatic  glands;  proclivity  to 
certain  forms  of  skin  eruption ;  to  disease  of  the  joints  and 
bones;  the  efforts  necessary  for  growth  and  development  overtax 
the  defective  vital  powers;  defective  quality  of  the  blood  and 
tissues,  and  especially  of  the  vascular  tissue  ;  injuries,  such  as 
sprains,  end  in  chronic  disease  of  the  joint.  A  scrofulous  child 
may  grow  finely  for  several  years,  and  then,  without  adequate 
cause,  be  overtaken  by  meningitis  or  disease  of  vertebrae;  inflam- 
mations are  prone  to  take  on  chronic  form. 

Treatment. — Pure  air  of  country,  cod-liver  oil  and  malt,  iron 
and  hypophosphites  to  increase  the  quantity  of  nutritious  con- 
stituents of  the  blood. 

J  Tumor  of  the  Upper  faw  is  indicated  bv  a  gradually  increas- 


DIAGNOSIS   OF   MOUTH   AFFECTIONS.  163 


ing  prominence  of  the  cheek,  which  more  or  less  involves  the 
mouth,  obstructing  the  nostril,  causing  double  vision  by  dis- 
placing the  eyeball. 

Treatment. — Removal  by  a  surgical  operation. 

j4  Malignant  Form  of  Tumor  of  the  faws  is  indicated  by  a  solid 
prominence,  rapid  in  growth,  and  having  a  tendency  to  invade 
surrounding  structures,  and  to  fungate  like  a  mushroom. 

Treatment. — Removal  by  a  surgical  operation,  and  the  applica- 
tion of  escharotics,  as  chromic  acid,  or  chloride  of  zinc,  etc.,  to 
prevent  its  reproduction. 

A  Dentigerous  Cyst. — Cysts  of  the  teeth  are  of  two  kinds — 
those  connected  with  the  roots  of  developed  or  eruptive  teeth, 
and  those  connected  with  imperfectly  developed  or  unerupted 
teeth,  and  both  varieties  are  common  to  either  jaw;  the  latter, 
however,  are  known  as  "  dentigerous  cysts."  A  dentigerous 
cyst  is  indicated  by  the  expansion  of  the  bone  of  the  jaw  at  some 
particular  spot,  with  disfigurement  of  the  adjacent  parts ;  a  sense 
of  weight  and  tension  in  the  affected  part ;  in  some  cases,  con- 
stitutional irritation  from  pressure ;  pressure  producing  a  parch- 
ment-like crackle  or  crepitation ;  absence  of  a  tooth,  which  has 
never  been  erupted  nor  extracted.  Heath  remarks  that  "  the 
clinical  history  of  cysts  connected  with  the  teeth  is  that  of 
painless  expansion  of  the  alveolus  of  either  jaw,  but  more  fre- 
quently of  the  upper,  with  crackling  of  the  bone  on  pressure, 
and  ultimate  absorption  of  the  bony  wall.  The  cyst  then  pre- 
sents a  bluish  appearance  through  the  distended  mucous  mem- 
brane, and  if  large,  gives  distinct  evidence  of  fluctuation." 

Treatment. — A  free  incision,  and  the  removal  of  the  unerupted 
tooth  by  destroying  the  front  wall  of  the  cyst,  and  the  cavity 
filled  with  antiseptic  gauze  or  lint,  so  as  to  induce  granulation 
and  gradual  obliteration.  In  the  case  of  a  cyst  of  the  lower  jaw, 
after  the  removal  of  the  contents  and  a  portion  of  the  wall,  the 
plates  of  bone  should  be  pressed  together  as  much  as  is  possible. 

Jn  Unerupted  Impacted  Tooth  is  indicated  by  a  hard,  bony  tumor 
on  the  alveolar  ridge,  sometimes  extending  along  the  surface  of 
the  palate  bone,  or  the  body  of  the  maxilla,  and  in  form  corre- 
sponding to  a  tooth,  the  absence  of  which  is  noted. 


1G4  DENTAL  MEDICINE. 

Treatment. — Extraction,  by  first  making  an  incision  through 
the  mucous  membrane,  and  then  exposing  the  tooth  by  the 
removal  of  its  bony  capsule. 

Necrosis  of  the  'Jaw  is  indicated  by  inflammation  like  that  of 
periodontitis  in  the  early  stage,  but  differing  as  the  disease  pro- 
gresses; gum  over  affected  part  thickened,  tumid  and  of  a  red 
color;  pus  oozing  from  the  edge  of  gum,  which  soon  separates 
from  the  alveolus,  the  margins  of  which  become  exposed  ;  loosen- 
ing and  loss  of  the  teeth  ;  the  detachment  of  the  dead  alveoli 
from  the  living  bone,  and  remaining  loose  in  the  substance  of  the 
thickened  gum  which  becomes  dark  in  color,  surrounded  by  pus ; 
the  escape  of  the  pus  into  the  mouth,  or  pointing  below  the  chin, 
or  beneath  the  fascia  of  the  neck,  as  low,  at  times,  as  the  clavicle. 

Treatment. — Remove  the  dead  portions  from  the  living  bone. 
Syringe  with  peroxide  of  hydrogen,  or  caustic  pyrozone,  to  cleanse 
the  part,  and  use  chlorinated  washes,  such  as  chloride  of  soda  or 
permanganate  of  potash,  to  correct  the  offensive  odor  and  disa- 
greeable taste.  Make  daily  applications  of  dilute  aromatic  sul- 
phuric acid,  adding  to  the  acid  a  few  drops  of  the  tincture  of 
capsicum  for  its  stimulating  effect;  diluted  carbolic  acid,  tincture 
of  iodine  and  chloride  of  zinc,  sulphate  of  copper,  listerine  and 
ethereal  solution  of  iodoform,  aristol,  etc.,  are  also  used  as  appli- 
cations. Support  the  strength  by  stimulants,  tonics  and  nour- 
ishing diet.  For  a  dead  bone  solvent,  wash  out  the  sinus  with 
peroxide  of  hydrogen,  and  inject  into  it  the  following,  twice  a 
day,  so  that  it  will  come  in  contact  with  the  dead  bone  :  Pure 
scale  pepsin,  5ss ;  nitro-muriatic  acid,  5j ;  distilled  water,  Oj. 
(See  Necrosis  and  Caries  of  Bone.) 

Dislocation  of  the  Lower  faw,  when  double,  is  indicated  by 
inability  to  close  the  mouth ;  the  mouth  widely  open  ;  the  chin 
prominent,  with  a  distinct  hollow  in  front  of  each  ear.  A  single 
dislocation  is  indicated  by  the  mouth  being  only  partially  open, 
the  chin  displaced  to  one  side,  the  distinct  hollow  below  the  ear 
being  on  the  opposite  side. 

Treatment. — Reduction  is  made  by  placing  the  thumbs,  pro- 
tected by  napkins,  as  far  back  upon  the  molars  as  possible,  and 
then  depressing  the   back  part  of  the  jaw,  and  at  the  same  time 


DIAGNOSIS   OF   MOUTH   AFFECTIONS.  165 

raising  the  chin.  The  jaws  should  afterwards  be  secured  by  a 
bandage  extending  under  the  chin  and  over  top  of  head. 

Fracture  of  the  Lower  Jaw  is  indicated  by  inability  to  close  the 
mouth,  and  to  speak  articulately  ;  laceration  of  the  gums  and 
hemorrhage  ;  irregularity  of  the  teeth  from  displacement  of  the 
fragments  of  bone ;  crepitation.  Fracture  of  the  maxilla  may, 
however,  show  no  displacement,  but  a  fracture  extending 
through  the  angle  or  ramus,  may  be  diagnosed  by  grasping  the 
two  sides  of  the  jaw  and  moving  them  forcibly.  Crepitus, 
increased  flow  of  saliva,  mobility  of  fragments,  and  irregularity 
of  the  teeth,  if  the  fracture  is  through  the  body  of  the  bone,  are 
all  signs  of  fracture.  A  swollen,  red  and  painful  condition  of  the 
tissues  covering  the  lower  jaw,  occurring  some  days  after  the 
accident,  denote  the  possibility  of  fracture,  neglect  causing  a  high 
degree  of  inflammation,  and  in  some  cases  even  necrosis  of  the 
bone. 

Treatment. — Reduce  by  bringing  the  displaced  portions  into 
apposition,  being  guided  by  the  arch  of  the  teeth,  and  then  secur- 
ing them  by  wire,  silk,  or  waxed  sterilized  ligatures  around  the 
teeth,  and  introducing  an  interdental  splint. 

Cleft  Palate  is  indicated  by  a  fissure  extending  through  the  soft 
palate  alone,  or  through  both  soft  and  hard  palates,  and  which 
mav  be  combined  with  single  or  double  hare-lip,  in  which  case 
the  intermaxillary  bones  are  frequently  displaced. 

Treatment. — When  the  cleft  is  confined  to  the  soft  palate,  the 
operation  of  staphylorraphy  may  be  performed  ;  when,  however, 
the  cleft  is  through  both  soft  and  hard  palates,  the  construction 
of  an  artificial  obturator  and  palate  combined  will  often  prove 
successful  in  correcting  the  voice  and  preventing  much  incon- 
venience in  partaking  of  food  and  drink. 

Hare-lip  is  indicated  by  a  congenital  fissure  of  the  upper  lip, 
and  may  be  single  or  double,  and  may  also  be  complicated  with 
fissure  of  the  hard  and  soft  palates. 

TreatTnent. — Pare  the  surfaces  of  the  edges  of  the  fissure  in  such 
a  manner  as  will  allow  a  flap  on  one  to  cover  the  edge  of  the 
other  when  they  are  brought  in  apposition,  when  they  are  secured 
by  the   aid  of  pins  and  the  figure-of-eight  suture,  which,  in  the 


-[QQ  DENTAL  MEDICINE. 

case  of  infants,  may  be  preserved  from  injury  by  passing  a  silver 
wire  through  the  cheeks,  having  on  each  protruding  end  a  button, 
to  prevent  the  breaking  up  of  the  suture  during  the  act  of  crying. 
Cocaine  is  a  useful  local  anaesthetic  for  such  operations. 

Facial  Paralysis  is  indicated  by  distortion  of  the  face,  in  which 
the  mouth  is  drawn  to  one  side,  being  due  to  paralvsis  of  the 
facial  nerve.  The  eye  may  also  remain  permanently  open  on  the 
affected  side,  the  saliva  escape  from  the  corner  of  the  mouth,  and 
the  food  collect  under  the  cheek,  on  account  of  the  paralysis  of 
the  buccinator  muscle. 

Treatment. — Electricity,  and  systematic  treatment  with  strych- 
nine, phosphorus,  iron,  quinine,  ergot,  etc. 

J  Nasal  Polypus  is  indicated  by  more  or  less  obstruction  of 
one  or  both  nostrils,  with  occasional  watery  discharge ;  a  gray  or 
yellowish  mass,  like  jelly  in  consistence,  can  be  detected  by  the 
finger,  if  it  is  passed  behind  the  soft  palate,  hanging  down  into  the 
pharynx,  and  which  increases  greatly  in  damp  weather;  the  nose 
bulged  out  on  one  side  by  the  growth  within. 

Treatment. — Remove  either  by  the  snare  or  by  torsion,  or  bv 
repeated  applications  of  chromic  acid.  To  prevent  reproduction 
apply  to  the  surface  chromic  acid  or  chloride  of  zinc. 

Thrush.,  common  to  infants  and  children  under  eighteen  months 
of  age,  is  indicated  by  small,  white  spots,  the  size  of  a  pin's  head, 
upon  the  dorsal  surface  of  the  tongue,  palate,  velum,  inside  of 
cheek  and  lips,  which  increase  in  size  and  coalesce,  with  a  tend- 
ency to  false  membrane,  the  crusts  falling  off  and  reappearing; 
the  mucous  membrane  beneath  redder  than  natural. 

Treatment. — Change  of  diet  and  residence,  if  these  are  at  fault; 
the  administration  of  saccharate  of  lime  in  milk.  Local  treat- 
ment, mel-boracis,  or  borax  solution,  or — 

li.     Sodii  borat .    .   i^j 

Glycerinae -^V] 

'  Aquae ^iv.     M. 

SiG. — Apply  with  a  camel's-hair  brush  four  or  five  times  a  day. 

Or— 

R.     Zinc  sulph "  .    .    .     •   .    .    .    .  gr.i-iv 

Aquae  rosse 5  ij.     M. 


DIAGNOSIS   OF   MOUTH   AFFECTIONS.  167 

Or  patches  touched  with  a  weak  solution  of  nitrate  of  silver ;  in 
severe  cases  gr.  v  to  water  f.  oj-  A  dose  of  castor  oil  or  calomel 
to  clear  the  alimentary  canal,  small  dose  of  chlorate  of  potash, — a 
few  grains  three  times  a  day,  attention  to  diet. 

Jphthce  or  Follicular  Ulceration^  common  to  childhood,  is  indi- 
cated by  the  mucous  membrane  becoming  inflamed,  and  the  for- 
mation of  small,  round,  transparent  vesicles  on  the  frasnum,  in  the 
sulcus  between  the  lips  and  gums,  and  on  lower  surface  of  tongue. 
On  the  bursting  of  the  vesicles,  small,  spreading  ulcers,  with  red 
and  swollen  margins,  appear,  which  become  coated  with  a  layer 
of  micro-organisms. 

Treatment. — Demulcent  applications,  such  as  mucilage  of  gum 
acacia,  or  flaxseed.  Mel-boracis  or  a  solution  of  boric  acid  in 
glycerole,  applied  with  a  camel's-hair  brush.  In  more  obstinate 
cases  touch  the  patches  with  a  solution  of  nitrate  of  silver — gr.  v 
to  f.  oj  of  water.  For  constitutional  symptoms,  administer  laxa- 
tives and  the  bromides,  with  warm  foot  bath. 

Epulis  is  indicated  by  a  growth  on  the  gums,  either  small  and 
pedunculated,  or  large  and  sessile. 

If  it  is  firm  in  texture  and  slow  of  growth,  the  epulis  is  generally 
fibrous ;  but  if  rapid  in  growth  and  dark  in  color,  it  is  myeloid ; 
if  prone  to  ulcerate  and  very  painful,  it  may  be  an  epithelioma. 

Treatment. — Removal  of  the  growth,  and  its  reproduction  pre- 
vented by  the  application  of  nitrate  of  silver,  or  chromic  acid,  or 
a  fire  cautery.  Generally  it  is  necessary  to  remove  the  perios- 
teum and  a  thin  scale  of  the  bone  beneath,  as  this  growth  is  con- 
nected with  the  periosteum.  Extract  all  roots  of  carious  teeth, 
and  when  the  epulis  is  connected  with  the  alveolar  cavity  of  a 
tooth  and  has  tendency  to  the  interior  of  the  jaw,  it  is  generally 
myeloid,  and  several  teeth  will  have  to  be  sacrificed,  so  that  the 
alveolus  can  be  thoroughly  excavated.  When  very  extensive,  a 
considerable  portion  of  the  alveolus  and  bone  of  the  jaw  must  be 
removed. 

Epithelioma  is  indicated  by  a  ragged  ulcer  on  the  lower  lip, 
commencing  as  a  wart,  the  skin  around  being  hard  and  infiltrated, 
with  enlargement  of  the  submaxillary  lymphatic  glands,  which 
become  tender,  or  even  ulcerated. 


168  DENTAL  MEDICINE. 


Epithelioma  of  the  gum  is  in  the  form  of  a  ragged  ulceration, 
often  the  result  of  irritation  from  diseased  teeth  ;  the  pain  and 
inconvenience  at  first  slight;  a  tending  of  the  ulceration  to 
spread  towards  the  tongue  and  cheek,  with  induration  of  the  base 
of  the  ulcer. 

Treatment. — Removal  as  soon  as  its  nature  is  manifest.  In 
slight  or  doubtful  cases  the  application  of  the  strongest  nitric 
acid,  the  acid  nitrate  of  mercury,  or  the  actual  cautery,  to  bring 
about  a  healthy  cicatrization.  If  the  disease  has  involved  the 
alveolus,  as  is  evident  by  the  swelling  of  the  gum  and  the  loose- 
ness of  the  teeth,  a  free  removal  of  the  bone  is  necessary. 

Hypertrophy  of  the  Gums  is  indicated  by  an  increase  of  their 
sui)stance  to  such  a  degree  as  to  cause  them  to  overhang  and 
cover  the  greater  portion  of  the  crowns  of  the  teeth  ;  tendency  to 
hemorrhage ;  gums  dark  and  livid  ;  fetor  of  breath  ;  increased 
flow  of  saliva. 

Treatment. — Remove  all  dead  teeth  and  salivary  calculus.  Re- 
move the  morbid  growth  by  a  horizontal  incision  through  the 
diseased  structure  to  the  crowns  of  the  teeth,  and  freely  scarify 
the  gums  by  passing  a  lancet  between  the  teeth  to  the  process, 
and  repeat  this  operation  at  intervals  of  four  or  five  days,  if 
necessary.  Use  detergent  and  astringent  and  antiseptic  lotions 
and  mouth-washes,  and  occasionally  a  weak  solution  of  nitrate  of 
silver.  Phenate  of  soda  is  efficacious  as  a  lotion,  it  is  also  antiseptic. 
Diet  non-irritating,  and  all  excess  and  intemperance  avoided. 
The  teeth  should  be  kept  perfectly  clean.  Trichloracetic  acid  to 
dissolve  calculus. 

Alveolar  Pyorrhoea^  or  Riggs'  Disease^  is  indicated  at  first  by  an 
uneasy  sensation  ;  then  inflammation  of  margins  of  gums  ;  loose- 
ness of  the  gums  about  the  teeth,  which  form  pus-pockets;  and 
necrosis  of  edges  of  alveolar  process  ;  a  tendency  to  hemorrhage  ; 
inflammation  extending  deeper  into  gums;  small  sulci  filled  with 
pus;  looseness  of  the  teeth  and  change  of  positions  ;  disagreeable 
taste ;  peculiar  fetor  of  breath  ;  dark  livid  color  of  gums,  with 
thick  margins,  and  often  extreme  sensitiveness  to  touch  ;  in  some 
cases  the  gums  are  denuded  of  their  epithelium,  with  a  polished 
appearance,  in    others,  with    a    pimpled    surface;  the    teeth,    at 


DIAGNOSIS   OF   MOUTH    AFFECTION'S.  1C9 

length,  held  in  their  cavities  by  a  tough,  ligamentous  attachment,  ■ 
due  to  the  degenerative  change  occurring  in  the  peridental  mem- 
brane. 

A  simple  form  of  this  disease  may  manifest  itself  at  the  margin 
of  the  gum,  indicating  its  presence  by  a  congested  appearance, 
beneath  which  may  be  found  a  granule  of  calcified  material. 
While  in  many  cases  there  is  general  congestion  of  the  affected 
gum,  and  a  proneness  to  hemorrhage,  in  other  cases  the  gum  may 
present  an  anaemic  appearance — pale  and  bloodless.  This  dis- 
ease may  also  be  associated  with  syphilis,  mercurial  salivation  and 
scurvy.  The  deposit  of  salivary  calculus  or  other  calcified  sub- 
stance is  supposed  to  be  secondary  to  the  disease,  as  a  deep-red 
and  denuded  gum  tissue  about  the  necks  of  the  teeth  may  be 
present  without  any  deposit. 

Dr.  Charles  B.  Atkinson  describes  this  affection  as  follows  : 
"  Perhaps  the  earliest  condition  presented  to  us  is  a  tumefaction 
of  the  margin  of  the  gum — from  pearly-red  and  light  lilac  to 
purplish-blue  in  tint — sometimes  puffing  to  such  an  extent  as  to 
be  easily  confounded  with  an  alveolar  abscess.  The  tumefied 
gum  bleeds  readily  on  brushing.  A  probe  passed  carefully  under 
the  gum  will  disclose  a  pocket  embracing  more  or  less  the  cir- 
cumference of  the  root,  in  some  places  nearly  or  quite  to  its 
apical  end.  Sometimes  the  gum  will  be  found  receded,  perhaps 
on  one  side  only.  A  purulent  discharge  more  or  less  marked, 
may  be  demonstrated  by  pressure  of  the  finger  over  the  root, 
from  its  end  towards  the  crown  of  the  tooth.  A  further  demon- 
stration of  the  pressure  of  pus  may  be  secured  by  injection, 
about  the  necks  of  the  teeth,  of  peroxide  of  hydrogen.  A  gen- 
eral hypertrophy  of  the  oral  tissues  mav  be  noticed.  Suppura- 
tion, perhaps  preceding,  perhaps  following,  a  solution  of  the 
dental  ligament,  which  permits  the  pocket  to  be  formed,  and  is 
the  antecedent  usually  responsible  for  the  loosening  of  the  teeth. 
This  loosening  may,  however,  be  present  as  a  result  of  inflamma- 
tion before  suppuration  has  succeeded.  The  loosening  mav  be 
attended  with  recession  of  the  gum  or  not,  and  with  or  without 
pain.  Locallv,  aside  from  the  gingival  congestions  already 
noticed,  the  teeth  may  be  found  elongated,  the  breath  fetid,  tartar 


170  DENTAL  MEDICINE. 

freely  present  (although  many  cases  progress  to  disaster  with  no 
appreciable  deposit  of  tartar),  pus  sometimes  oozing  from  the 
sockets,  putrid  taste  in  the  mouth,  tenderness  of  the  teeth,  already 
noted,  and  many  times  considerable  irregularities,  the  natural  re- 
sult of  the  loosening  of  the  teeth.  Observation  may  disclose 
such  systemic  conditions  as  stomach  dyspepsia,  catarrh  (as  nasal 
catarrh  or  other  mucous  surface  debility),  constipation,  phthisis, 
adenoid  growths,  general  congestion  due  to  intemperance,  kidney 
disease,  rheumatism,  cold  feet  and  other  extremities,  indicating 
poor  circulation  and  mal-assimilation.  Dr.  Rhein  has  truly  said 
that  incurable  systemic  disorders  make  only  palliation  of  pyor- 
rhoea disorders. 

Causes. — Dr.  Rehwinkel,  who  first  suggested  the  name 
"  pyorrhoea  alveolaris,"  ascribed  this  disease  to  constitutional 
and  hereditary  causes ;  Dr.  G.  C.  Davis  to  low  vitalitv  and 
feeble  vascularity  ;  Drs.  Witzel,  Arkovey,  and  Black,  that  it  is  a 
specific  infectious  disease ;  Dr.  L.  C.  Ingersol  attributed  it  to 
sanguinary  calculus;  Dr.  A.  O.  Rawls  to  mercurial  taint,  and 
the  effects  of  chloride  of  sodium  ;  Dr.  Talbot  to  perverted  con- 
ditions of  secretions,  low  vitality  and  sanguinary  calculus ;  Dr. 
J.  D.  Patterson  to  catarrh ;  Prof.  C.  N.  Peirce  to  its  being  a 
manifestation  of  the  gouty  diathesis,  having  found  uric  acid  and  its 
salts  at  the  apical  ends  of  roots.  Dr.  W.  X.  Sudduth  opposes  the 
uric  acid  theory  of  Prof.  Peirce,  as  also  does  Dr.  Younger,  who 
believes  it  to  be  of  local  origin,  and  due  to  diseased  activity  of 
the  pericementum,  caused  by  disturbed  nutrition  or  local  irrita- 
tion :   the  late  Dr.  fionwill  agreed  with  Dr.  Younger. 

Treatment. — The  first  and  one  of  the  most  important  indica- 
tions is  to  sterilize  the  mouth  so  that  pathogenic  organisms  will 
not  find  access  into  the  deep  parts  during  the  subsequent  opera- 
tions ;  then  to  remove  all  deposits  from  the  roots  of  the  teeth,  and  all 
necrosed  bone  from  the  margins  of  the  alveolar  processes.  This 
can  be  accomplished  with  what  are  known  as  Riggs'  instruments. 
An  acquired  and  acute  sense  of  touch  is  necessary  to  determine 
the  thoroughness  of  the  cleansing  operation.  The  pockets  formed 
in  the  gum  may  then  be  sterilized  by  syringing  with  a  three  per 
cent,  solution   of  pyrozone,  or  with    iodoform   and   eucalyptus, 


DIAGNOSIS   OF   MOUTH    AFFECTIONS.  171 

iodoform  and  oil  of  cinnamon,  or  with  injections  of  chloride  of 
alumina,  gr.  iij  to  the  ounce  of  water,  also  strong  tincture  of 
myrrh,  aromatic  sulphuric  acid,  nitrate  of  silver.  Peroxide  of 
hydrogen,  and  also  a  solution  of  iodide  of  zinc,  gr.  xii-xiv  to  the 
ounce  of  water,  are  also  recommended  by  Dr.  Harlan,  in  the 
form  of  injections  ;  and  for  chronic  cases  the  latter  is  a  solution 
composed  of  gr.  xxiv  to  the  ounce  of  water,  after  the  parts  are 
cleansed  by  injections  of  the  peroxide  of  hydrogen.  Another 
method  :  After  thorough  removal  of  deposits,  syringe  with  aro- 
matic sulphuric  acid,  diluted  with  one-half  water,  and  apply  night 
and  morning  a  powder  composed  of  creta  preparatae,  5j ;  acidum 
boricum,  .^j.  The  use  of  "  Robinson's  Remedy  "  is  also  recom- 
mended, following  the  use  of  bichloride  of  mercury  i  to  500. 
An  antiseptic  and  astringent  mouth-wash  should  be  employed 
frequently  until  the  gums  reattach  themselves  to  the  teeth. 

Dr.  Chas.  B.  Atkinson  recommends  first  returning  loose  teeth 
to  place  laterally,  and  securing  them  with  waxed  sterilized  liga- 
tures. Then,  beginning  with  the  upper  jaw,  such  scaling  as  may 
be  indicated  should  be  performed,  after  which  the  pockets  should 
be  carefully  investigated  with  proper  instruments,  all  foreign 
matter  removed  from  them  and  from  about  the  teeth,  having 
recourse  frequently  to  a  -J^  or  yj^ff  solution  of  HgClj  in  HjO,. 
This  preparation  of  peroxide  should  be  first  allowed  to  remain  in 
the  pockets  and  about  the  teeth  for  perhaps  even  three  minutes. 
It  may  be  necessary  to  reduce  the  length  of  elongated  teeth,  but 
if  direct  pressure  will  answer,  this  should  be  resorted  to  and 
shortening  of  the  bite  avoided.  See  the  patient  daily  for  two 
weeks.  Sometimes  no  application  of  medicaments  will  be  in- 
dicated— perhaps  a  little  scaling  or  scraping  of  overlooked  de- 
posit, from  time  to  time.  The  appearances  of  the  abnormal 
conditions  seem  to  be  best  indicated  by  color,  size  and  texture. 
A  dark  blue  color  of  soft  and  spongv  gum  should  be  lanced  to 
relieve  the  venous  congestion,  and  then  injected  with  aromatic 
sulphuric  acid,  full  officinal  strength.  Should  suppuration  be 
imminent  or  present,  the  pus  should  be  evacuated  by  incision,  or 
by  the  injection  of  peroxide  of  hydrogen  as  a  first  step,  followed 
by  a  delicate  application  of  "  caustic  paste  "  (potassa  fusa  ^,  car- 


1Y2  DENTAL  MEDICINE. 


bolic  acid,  cryst.  ^).  A  cherry-red  color  of  slightly  puffed  gum 
calls  for  salicylic  acid  solution  saturated  in  95  per  cent,  alcohol. 
The  constant  exhibition  of  antiseptic  and  stimulant  mouth-washes 
is  necessary,  such  as  combinations  of  bichloride  of  mercury,  tinc- 
ture of  calendula  and  distilled  water,  or  hydronaphthol,  tincture 
of  calendula  and  distilled  water ;  or  peroxide  of  hydrogen  and 
tincture  of  calendula.  Systemic  remedies  are  also  indicated,  such 
as  tonics  and  cathartics,  the  latter  in  the  beginning  of  the  treat- 
ment; also  digestive  stimulation. 

Dr.  E.  C.  Kirk  recommends  a  ten  per  cent,  solution  of  aristol, 
rubbed  up  with  oil  of  cinnamon,  or  oil  of  gaultheria  and  intro- 
duced into  each  suppurating  pocket,  and  around  the  roots  of  the 
teeth  at  the  base  of  each  pocket,  on  wisps  of  absorbent  cotton, 
saturated  with  the  solution ;  also  saturated  solutions  of  sulphate 
of  zinc  and  iodide  of  potassium,  equal  parts,  in  turn  saturated 
with  crystals  of  iodine;  also,  pyrozone  five  per  cent,  solution,  or 
peroxide  of  sodium,  or  loretin,  or  trichloracetic  acid  alone  or  in 
combination  with  pyrozone,  or  glycozone,  or  bitartrate  of  lithia, 
internally.  Dr.  Bodecker  recommends  applying  nitrate  of  silver 
by  making  a  small  platinum  wire  loop,  warming  it,  and  then 
dipping  it  into  powdered  nitrate  of  silver  and  carrying  into  the 
pockets.  Rinsing  the  mouth  before  and  after  the  application 
with  salt  water  will  prevent  injury  to  surrounding  tissues.  Dr. 
Payne  recommends  warm  distilled  water  followed  by  five  per 
cent,  solution  of  pyrozone,  and  then  a  concentrated  solution  of 
lactic  acid.  Dr.  Gordon  White  recommends  lactic  acid,  and 
where  roots  are  very  sensitive  uses  lactate  of  silver.  Dr.  Kirk 
recommends  trichloracetic  acid  to  facilitate  removal  of  deposits  : 
also  Dr.  Jarvie,  and  also  sulphuric  acid.  Dr.  B.  F.  Arrington 
medicates  with  sulphuric  acid,  campho-phenique,  and  carbolic 
acid.  Dr.  Essig  recommends  aqueous  solutions  of  chloride  of 
zinc,  after  all  deposits  are  removed.  Prof.  Peirce  recommends 
placing  patient  on  an  albuminous  diet,  and  tablets  of  citrate  of 
lithium.  The  cataphoric  current  with  such  medicines  as  are 
conductive,  and  also  beneficial  in  the  treatment  of  alveolar  pyor- 
rhcea,  it  is  claimed,  will  increase  their  efficiency. 

Irritation  of  the  Dental  Pulp  is  indicated  by  an  uneasy  sensation 


DIAGNOSIS   OF   MOUTH    AFFECTIONS.  173 

which  develops  into  pain  of  a  gnawing  or  burning  character,  the 
affected  tooth  being  sensitive  to  changes  of  temperature,  painful 
in  mastication,  but  exhibiting  no  symptoms  of  inflammation  of 
the  gum  or  peridental  membrane. 

Treatment. — The  treatment  must  vary  with  the  condition  pro- 
ducing the  affection.  First  remove  all  irritants.  If  the  cause  is 
systemic,  constitutional  treatment  for  the  condition  present  is  in- 
dicated. Saline  cathartics,  as  the  sulphate  or  carbonate  of  mag- 
nesia; diaphoretics,  as  spts.  mindererus,  or  Dover's  powder; 
diuretics,  as  preparations  of  nitre,  often  prove  efficacious ;  also 
bromide  of  potassium.  If  the  fluids  of  the  mouth  are  irritative, 
they  must  be  corrected.  If  a  carious  cavity  exists,  all  foreign 
substances  and  the  softer  parts  of  carious  dentine  should  be  re- 
moved, and  the  cavity  syringed  with  a  tepid  solution  of  bicarbon- 
ate of  soda,  potash  or  ammonia.  Dilute  carbolic  acid,  or  wood 
creasote,  may  then  be  applied,  and  a  non-conducting  filling  of  a 
solution  of  gutta  percha  and  chloroform  be  introduced.  (See 
Dental  Formulae  for  Odontalgia  and  Pulpitis.) 

Jcute  Inflammation  of  the  Dental  Pulp  is  indicated  by  acute 
pain  in  the  affected  tooth,  which  frequently  extends  to  neighbor- 
ing teeth  and  to  the  side  of  the  face,  but  is  more  intense  in  the 
tooth  itself;  pain  may  subside  after  a  few  hours'  duration,  to 
return  again  on  the  slightest  provocation,  or  on  patient  assuming 
a  horizontal  position ;  the  pain  may  also  assume  a  throbbing 
character. 

Treatment. — The  treatment  of  this  condition  of  pulp  is  indi- 
cated in  that  of  "  irritation  of  the  pulp."  For  soothing  appli- 
cations, solution  of  gutta  percha  and  chloroform,  tincture  of 
hamamelis  applied  warm,  oil  of  cloves,  dilute  creasote,  equal 
parts  of  chloroform,  aconite  and  tincture  of  opium,  may  be  em- 
ployed.    (See  Dental  Formulae  for  Odontalgia  and  Pulpitis.) 

Chronic  Injlammation  of  the  Dental  Pulp  is  indicated  by  pain, 
less  severe  than  in  the  acute  form,  and  of  less  duration  ;  coming 
on  at  irregular  intervals,  and  wandering,  like  neuralgic  pains,  and 
incited  by  changes  of  temperature,  and  the  application  of  irritants. 
(See  Irritation  of  Dental  Pulp.) 

Fungous   Growth  of  Pulp  is  indicated  by  the  organ,  as  a  result 


174  DENTAL  MEDICINE. 


of  continued  irritation,  assuming  the  form  of  a  small  vascular 
tumor  or  granular  mass,  attached  by  means  of  a  pedicle,  and 
which,  in  some  cases,  completely  fills  the  cavity  of  decay  in  the 
crown  of  the  tooth,  and  is  often  extremely  sensitive  and  prone 
to  hemorrhage. 

Treatment. — When  a  tendency  to  fungous  growth  is  discov- 
ered, the  free  application  of  carbolic  acid  or  tincture  of  aconite 
followed  by  the  use  of  chromic  acid,  will  obtund  the  sensibility, 
when  the  entire  tumor  should  be  excised,  and  its  reproduction 
prevented  by  application  of  nitric  acid  on  a  disc  of  cardboard. 

Putrescent  Pulps. — Dr.  Callahan's  treatment  with  sulphuric  acid, 
which  agent  destroys  all  animal  tissues  by  dehydration  on  account 
of  its  strong  affinity  for  water,  has  proven  very  effectual.  The 
immediate  application  of  bicarbonate  of  soda  will  neutralize  its 
action  on  the  tooth-structure.  Peroxide  of  sodium,  hydronaphthol, 
oil  of  gaultheria,  Black's  i,  2,  3  mixture,  iodoform,  iodol,  hydro- 
chloric acid  with  pepsin,  permanganate  of  potash,  pyrozone, 
thymol,  peroxide  of  hydrogen,  peroxide  of  sodium,  papaine, 
eugenol,  eucalyptol,  formalin,  oil  of  cloves,  bichloride  of  mercury, 
iodine  and  aconite,  cataphoric  current  with  a  solution  or  agent 
which  possesses  conductivity,  iodoform  vapor  or  fumes,  dehydra- 
tion, etc.,  have  all  been  employed  with  success. 

Ossification  {^Calcification^  of  the  Dental  Pulp  is  indicated  by  pain  of 
a  neuralgic  character,  which  commences  in  an  uneasy  feeling,  and 
changes  to  what  has  been  described  as  a  gnawing  sensation,  similar 
to  that  which  attends  the  knitting  together  of  the  fractured  parts 
of  a  bone.  It  may  be  continuous,  but  not  constantly  severe,  and 
frequently  amounts  to  no  more  than  an  uneasy  sensation ;  at 
other  times  it  may  be  sharp  and  darting,  affecting  the  side  of  the 
head,  and  all  the  branches  of  the  superior  maxillary  division  of 
the  fifth  pair  of  nerves.  The  affected  tooth  is  free  from  sore- 
ness and  discoloration. 

Treatment. — Apply  anodynes,  such  as  lead  water,  and  those 
indicated  in  "  acute  inflammation  of  pulp  "  to  relieve  the  pain. 
Open  the  pulp  chamber,  and  completely  extirpate  the  pulp. 

Hypersensitiveness  or  Abnormal  Sensibility  of  Dentine  is  indicated 
by  pain  resulting  from  irritation  of  dentinal  structure,  being  of 


DIAGNOSIS   OF   MOUTH    AFFECTIONS.  175 

shorter  duration  and  less  acute  in  character  than  that  from  an 
inflamed  dental  pulp;  the  pain  of  sensitive  dentine  soon  subsides 
on  the  removal  of  the  irritating  cause. 

Treatment. — Apply  obtunding  agents,  as  chloride  of  zinc, 
chloroform  and  aconite  equal  parts,  carvacrol,  oil  of  cloves, 
oil  of  cedar,  oil  of  eucalyptus,  tannin  combined  with  glycerine 
or  camphor,  chloral,  camphorized  ether,  oxide  of  calcium,  car- 
bonate of  sodium,  menthol,  thymol,  sesquichloride  of  chromium, 
sulphate  of  morphine  and  gum  camphor  equal  parts,  ethylate  of 
sodium,  carbonate  of  potash  and  glycerine,  carbolized  potash, 
campho-phenique ;  also  chloride  of  ethyl,  phenate  of  cocaine, 
tropacocaine,  peroxide  of  sodium,  vapocaine,  eucaine,  chlore- 
tone,  etc.  The  cataphoric  current  with  warm  saline  solutions  of 
cocaine,  or  the  solution  of  cocaine  with  electrozone,  or  cocaine 
dissolved  in  a  ten  per  cent,  solution  of  chloride  of  sodium.  The 
application  of  chloretone  in  the  form  of  a  saturated  ethereal  solu- 
tion has  given  very  satisfactory  results ;  also  the  ethereal  solu- 
tion of  the  salt  of  cocaine  known  as  vapocaine.  Ottolengui's 
method  :  Apply  the  rubberdam,  dry  cavity  with  bibulous  paper, 
then  insert  a  pledget  of  cotton  saturated  with  absolute  alcohol, 
then  apply  intermittingly  a  series  of  blasts  of  hot  air  to  produce 
evaporation,  until  parts  become  whitened  or  thoroughly  dry,  then 
throw  on  a  continuous  spray  of  ether.  A  jet  of  nitrous  oxide 
gas  directed  into  the  cavity  of  the  tooth  by  a  piece  of  tubing  ; 
also  the  vapor  of  alcohol,  produced  by  heating  the  alcohol  in  a 
metal  apparatus,  and  conducting  the  vapor  into  the  cavity  through 
a  fine  metal  tube,  have  also  been  employed  for  the  relief  of  the 
pain  arising  from  hypersensitive  dentine.  The  application  of 
cocaine  and  alcohol  by  electrolysis  has  also  given  satisfactory 
results.     (See  Therapeutics  of  Electricity.) 

Abrasion  of  the  Teeth  is  indicated  by  a  loss  of  structure,  due 
to  friction,  to  such  an  extent  at  times  as  to  destroy  the  entire 
crowns. 

Treatment. — Gold  caps  or  partial  crowns,  either  in  the  form 
of  ferrules  or  contour  fillings,  or  fillings  of  other  metals,  will 
often  arrest  the  process  of  abrasion,  and  render  much  worn 
teeth    useful   organs.     Also   the    insertion    of  artificial    posterior 


176  DENTAL  MEDICINE. 


teeth  will  often  prevent  natural  front  teeth  from  being  abraded 
by  unnatural  use. 

Hypertrophy  of  the  Alveolar  Processes  is  indicated  by  an  osseous 
deposit,  either  at  the  apex  of  the  alveolar  cavity,  in  which  case 
the  affected  tooth  is  protruded  from  its  cavity,  or  by  a  deposit  of 
osseous  matter  on  the  wall  of  the  alveolar  cavity,  in  which  case 
the  tooth  is  forced  to  one  side. 

Treatment. — When  the  osseous  deposit  is  in  the  bottom  of  the 
alveolar  cavity,  the  length  of  the  tooth  may  be  reduced  from 
time  to  time  until  a  certain  degree  is  reached,  when  the  loss  of 
the  tooth  is  inevitable.  When  the  deposit  is  upon  the  side  of 
the  cavity,  the  effect  is  irregularity  or  malposition,  for  which 
there  is  often  no  remedy  but  the  removal  of  the  deviating 
tooth. 

Hypercementosis  or  Dental  Exostosis  is  indicated  by  an  uneasy 
sensation  in  the  affected  tooth,  followed  by  a  gnawing  pain, 
which  in  some  cases,  assumes  a  severe  neuralgic  character, 
especially  when  the  deposit  of  cementum  on  the  root  is  of  con- 
siderable size,  in  which  case  there  is  a  prominence  apparent  on 
the  side  of  the  alveolar  ridge. 

Treatment. — During  the  early  stages  of  this  affection,  the 
administration  of  large  doses  of  iodide  of  potassium,  and  the 
application  of  counter-irritants,  such  as  a  saturated  tincture  of 
iodine  or  cantharidal  collodion,  have  been  suggested,  to  arrest 
the  deposit  and  cause  absorption.  When  the  deposit  is  large 
and  productive  of  pain  and  inconvenience,  the  removal  of  the 
affected  tooth  is  inevitable. 

Edentulous  Neuralgia. — Caused  by  hypertrophy  of  the  inferior 
dental  nerve  in  aged  persons  in  the  absence  of  all  the  teeth,  after 
the  nerve  makes  its  exit  through  the  dental  foramen.  The 
remedy  is  a  saddle-shaped  plate  for  the  artificial  denture  worn,  so 
that  the  pressure  is  distributed  to  surrounding  parts  and  not 
exerted  upon  the  nerve  as  it  passes  out  of  the  foramen. 

Organic  Defects  of  Structure^  indicated  by  defects  in  the  enamel, 
in  the  form  of  opaque  spots,  grooves  or  pits,  congenital  in  origin, 
and  due  to  altered  functions  from  impaired  nutrition. 

Treatment. — Preventive  by  mitigating  severity  of  diseases  pro- 


DIAGNOSIS   OF   MOUTH   AFFECTIONS.  177 

ducing  the  condition,  by  the  administration  of  proper  remedies. 
For  the  pitting  variety,  properly  inserted  fillings. 

Odontomes  are  indicated  by  irregular  masses  of  dental  tissues, 
which  result  from  morbid  conditions  of  the  formative  pulp,  such 
as  nodules  of  enamel  and  dentine,  hypertrophy  of  cementum, 
etc.,  some  being  congenital,  others  induced. 

Treatment. — Extraction,  when  they  are  a  source  of  irritation, 
or  an  injury  to  the  normal  teeth,  or  are  unsightly. 

Syphilitic  Teeth  are  indicated  by  notches,  generally  crescentic, 
in  the  cutting  edges  of  the  incisors,  and  peg-like  shaped  cuspids  ; 
also,  a  dark  color  and  soft  consistence  are  characteristic  of  such 
teeth. 

Treatment. — The  most  skilful  treatment  by  properly  intro- 
duced fillings  and  constant  attention,  are  necessary  for  their 
preservation. 

Erosion  of  the  Teeth  is  a  progressive  chemical  solution  of  the 
enamel  of  the  labial  surfaces  of  the  incisors,  canines,  and  some- 
times of  the  bicuspids,  generally  in  the  form  of  a  continuous 
horizontal  groove,  smooth  and  regular,  and  not  due  to  caries  or 
mechanical  abrasion  ;  in  some  cases  it  may  extend  over  nearly  the 
whole  of  the  labial  surface,  the  color  of  the  enamel  being  rarely 
changed.  Erosion  is  the  removal  of  the  surface  of  the  enamel, 
without  apparent  cause,  although  it  has  been  ascribed  to  an  altered 
secretion  of  the  labial  follicular  glands,  acid  in  reaction  probably 
being  the  solvent.  It  is  usually  found  in  persons  with  a  gouty 
diathesis.  Its  first  appearance  consists  of  a  slight  cup-  or  dish- 
shaped  cavity  in  the  enamel  a  short  distance  from  the  margin 
of  the  gum,  usually  on  the  anterior  surfaces  of  the  front  teeth, 
although  it  is  not  confined  to  such  teeth,  the  small  excavations 
gradually  broadening  and  deepening  until  the  surface  of  the 
dentine  becomes  exposed,  which  remains  hard  and  finely  polished  ; 
and  a  pit  or  groove  is  at  length  formed  which  gradually  widens 
and  deepens  until  a  considerable  portion  of  the  crown  of  the 
tooth  is  destroyed.  The  affected  area  of  tooth  structure  remains 
polished,  and  the  invasion  of  the  dentine  is  less  rapid  than  the 
surface  destruction  of  the  enamel.  True  erosion  differs  from  the 
destruction  of  the  enamel  in  the  form  of  pits  and  irregularities 
12 


178  DENTAL  MEDICINE. 


due  to  an  acid  condition  of  the  fluids  of  the  mouth,  lactic  acid 
being  a  prominent  factor  in  promoting  fermentative  action. 

Treatment. — The  continued  use  of  alkaline  applications  and 
alkaline  mouth-washes.  Phillips'  milk  of  magnesia  is  an  excellent 
application.  In  advanced  stages,  its  progress  may  be  arrested  by 
fillings  of  durable  material. 

Absorption  of  Process  and  Recession  of  Gum  is  indicated  by  a 
slight  increase  of  redness,  some  congestion  and  a  shrinkage  of  the 
margins  of  the  gums,  and  may  be  accompanied  with  a  slight 
purulent  discharge  about  the  neck  of  the  affected  tooth.  The 
symptoms  resemble  those  of  chronic  inflammation  of  the  gums. 
The  progress  of  the  affection  is  generally  slow,  and  it  is  often 
first  observed  about  the  necks  of  the  canine  teeth.  Teeth  so 
affected  become  more  susceptible  to  impressions  of  heat,  colds, 
acids,  etc.,  and  eventually  loose. 

Treatment, — To  arrest  the  progress  of  this  affection,  first 
remove  all  irritants,  and  cleanse  thoroughly,  polishing  the  exposed 
surfaces.  Correct  the  nature  of  the  fluids  of  the  mouth,  if  at 
fault,  by  constitutional  treatment,  the  use  of  alkaline  lotions,  such 
as  lime  water,  and  detergent  dentifrices.  Such  agents  as  a  weak 
solution  of  chloride  of  zinc,  to  produce  healthy  granulation, 
carbolic  acid,  nitrate  of  silver,  and  judicious  pressure,  may  be 
employed  with  advantage.  A  moderately  stiff  brush  and  floss 
silk  are  useful  adjuncts  to  the  treatment. 

Necrosed  Teeth.— T^he  term  "  necrosed  "  is  applied  to  a  tooth 
when  the  vitality  of  its  pulp  and  lining  membrane  is  destroyed, 
the  peridental  membrane,  however,  maintaining  a  degree  of  vitality 
which  prevents  the  tooth  from  becoming  an  irritant,  so  as  to 
insure  its  loss  as  an  effete  organ. 

Treatment. — When  a  necrosed  tooth  is  not  productive  of  injury 
to  the  adjacent  structures,  and  there  is  a  probability  of  rendering 
it  a  useful  organ,  the  pulp  canal  should  be  thoroughly  exposed, 
cleansed,  and  irrigated  with  disinfectants,  antiseptics,  etc., 
and  then  filled,  together  with  the  crown  cavity,  with  a  suit- 
able material.  As  necrosed  teeth  are  frequently  considerably 
discolored,  on  account  of  the  tubuli  of  the  dentine  absorbing 
coloring   matter   from   the   dead  pulp,  such   bleaching  agents   as 


DIAGNOSIS   OF   MOUTH    AFFECTIONS,  I79 

chloride  of  lime,  chloride  of  alumina,  oxalic  acid,  chloride  of  soda, 
sulphite  of  soda,  combined  with  boracic  acid,  cyanide  of  potassium, 
tartaric  acid  in  combination  with  chloride  of  lime,  chloride  of 
zinc,  also  alum  in  combination  with  liq.  sodae  chlorinatae,  may  be 
employed  to  improve  their  appearance,  also  use  of  nitrous  oxide 
in  combination  with  chloride  of  sodium,  also  peroxide  of  hy- 
drogen, or  pyrozone. 

Infantile  Paralysis  during  the  Period  of  Teething. — Infantile 
paralysis,  or  poliomyelitis,  is  an  obscure  affection  peculiar  to  a 
certain  season,  which  has  given  to  it  at  the  hands  of  some  the 
name  of  "  warm  weather  spinal  disease."  It  comes  on  suddenly, 
but  seldom  after  the  age  of  four  years.  According  to  Gowers, 
of  all  cases  under  ten  years,  three-fifths  occur  in  the  first  two 
years  of  life ;  and  he  claims  that  a  considerable  number  of  cases 
are  congenital.  There  is  usually  a  febrile  initial  stage  followed 
by  the  sudden  onset  of  paralysis  in  one  leg  or  arm.  In  more  than 
half  the  cases  the  lower  limbs  are  affected  ;  of  the  remainder,  the 
majority  represent  implications  of  the  arms,  notably  the  deltoid 
muscles,  and  legs,  or,  perhaps,  arm  and  leg,  and  very  seldom  the 
upper  extremity  alone.  The  cause  of  infantile  paralysis  is  gen- 
erally assigned  to  teething,  cold  or  damp,  injuries  to  the  spine, 
measles,  scarlatina,  malarial  or  other  fevers,  convulsions  or  con- 
cussion. Dr.  Rot,  at  the  Fourth  Prussian  Congress,  declared 
that  heredity  is  the  only  etiological  factor  that  has  been  proven. 
*'  The  primary  cause  of  the  affection  must  be  sought  for  in"  the 
modifications  of  that  part  of  the  fecundated  ovum  which  enters 
into  the  formation  of  the  nervous  system."  During  the  period 
of  dentition,  children  are  liable  to  disorders  of  the  cerebro- 
spinal system,  and  as  from  such  causes  we  find  convulsions  the 
cause  of  the  death  of  numberless  infants  seemingly  robust,  so  we 
see  the  same  cause  producing  paralysis.  There  is  loss  of  heat 
and  atrophy  in  the  affected  limbs,  and  the  latter  may  be  a  feature 
of  the  disease  dependent  upon  the  morbid  changes  in  the  nerve- 
centres.  The  atrophy  extends  to  the  bony  system,  the  nutrition 
of  which  is  involved;  and  it  is  evident  that  the  atrophic  degener- 
ation, if  not  inherent,  is  a  real  sequence  of  inflammatory  process 
in  the  spinal  cord. 


180  DENTAL  MEDICINE. 


Treatment. — The  treatment  of  infantile  paralysis  consists  in  the 
application  of  mild  galvanic  stimulation  by  the  uninterrupted 
current  conveyed  through  the  affected  cord  out  through  the 
nerves  of  the  flabby  muscles;  the  skin  may  also  be  stimulated 
with  salt  and  sulphur  baths.  In  the  early  stage  Dr.  Althaus 
advises  the  injection  of  ergotine  ^  gr.,  for  a  child  a  year  old,  in 
order  to  contract  the  arterioles  of  the  part  to  deplete  the  blood 
supply.  He  stimulates  the  muscles  as  they  become  affected  with 
injections  of  strychnine.  Conium  and  chloral  may  be  used  to 
calm  nervous  excitement.  Dr.  Sequin  recommends  counter- 
irritation  over  the  spine,  bromides  and  arsenic,  while  others  use 
cupping,  leeches,  and  iodide  of  potassium.  Brown-Sequard 
recommended  belladonna  to  control  the  inflammatory  process  of 
the  spinal  cord.  If  pain  or  fever  are  present,  ether  spray  to  the 
spine,  ice,  gelsemium,  aconite,  antipyrine  internally.  Rubbing, 
muscle-beating  and  massage  have  also  been  employed  as  adjuncts. 

Chemical  Bleaching  of  Teeth. — Prof.  Truman's  method  consists 
in  liberating  chlorine  from  calcium,  hydrochlorite,  or  chloride  of 
lime,  in  the  cavity  of  decay  and  pulp  canal  by  a  dilute  acid.  He 
recommends  a  fifty  per  cent,  solution  of  acetic  acid,  although 
oxalic,  citric  or  tartaric  acid  may  be  used,  or  indeed  any  dilute 
acid  to  liberate  the  chlorine.  The  upper  third  of  the  pulp  canal 
should  be  filled  with  gutta  percha,  and  the  cavity  in  all  cases 
should  be  washed  out  with  ammonia  or  borax,  to  remove  the 
fatty  matter  previous  to  the  introduction  of  the  bleaching  agent. 
Labarraque's  solution  of  soda  has  also  been  used  as  a  medium 
from  which  to  liberate  the  chlorine.  Dr.  A.  W.  Harlan  uses 
aluminum  chloride  in  the  cavity,  from  which  he  liberates  the 
chlorine  by  means  of  peroxide  of  hydrogen.  Dr.  Edw.  C.  Kirk's 
method  consists  of  liberating  sulphurous  acid,  S02,  from  sodium 
sulphite,  Na2S03,  by  means  of  boracic  acid.  The  two  sub- 
stances, in  the  proportion  of  100  grains  of  sodium  sulphite  and 
70  grains  of  boracic  acid,  are  desiccated  separately,  and  then  in- 
timately ground  together  in  a  warm  dry  mortar.  In  using  this 
powder,  the  tooth  is  carefully  dried  under  the  dam,  and  the 
powder  is  packed  into  the  pulp-cavity  and  cavity  until  both  are 
full;  the   reaction   which  liberates   the   sulphurous   acid  is  then 


DIAGNOSIS   OF   MOUTH   AFFECTIONS.  181 

brought  about  by  moistening  the  powder  in  the  tooth  with  a  drop 
of  water,  and  the  orifice  of  the  cavity  is  immediately  closed  with 
warm  gutta  percha ;  also  peroxide  of  sodium  50  per  cent,  solution 
followed  by  application  of  a  dilute  acid,  such  as  sulphuric  hydro- 
chlorine,  or  trichloracetic,  all  applied  on  asbestos  fibre ;  also 
pyrozone,  5  per  cent,  and  25  per  cent,  solutions ;  also  decompos- 
ing chloride  of  magnesia  or  chloride  of  tin  with  peroxide  of 
hydrogen  within  the  tooth.     (See  Cataphoresis.) 

Herpes  Zoster  of  Mouth  and  Gums. — An  acute  circumscribed 
inflammatory  affection,  characterized  by  an  eruption  of  vesicles 
of  herpes  on  a  red,  inflamed  basis,  the  vesicles  being  disposed  in 
groups  and  follow  the  group  of  the  adjacent  nerve.  The  erup- 
tion is  preceded  and  accompanied  by  a  very  severe  neuralgia  of 
the  fifth  nerve.  The  period  of  invasion  (three  days)  is  accom- 
panied by  a  well-defined  fever  and  other  general  symptoms.  The 
period  of  eruption  begins  on  the  third  day,  and  lasts  about  three 
weeks  to  one  month,  the  pain  being  persistent.  It  is  probably  of 
an  infectious  origin,  and  is  due  to  a  neuritis  of  the  affected  region 
which  leads  to  tropic  changes. 

Treatment. — Dr.  Harlan  recommends  a  palliative  treatment, 
which  consists  in  placing  cotton-wool  between  the  cheek  and 
teeth  to  prevent  friction,  and  on  it  an  ointment  consisting  of 
cocaine  and  morphine. 

Merck's  Bulletin  gives  the  following. new  treatment  for  herpes 
zoster  : 

MIXTURE. 

JJ .    Extract  gelsemium  ) 

r.  J.  ,  ,  ,    ,        >  of  each  4  grammes, 

oodium  sulpho-carbolate  J 

Distilled  water 90  grammes.     M. 

Sig.     One  teaspoonful  every  two  hours. 

At  the  same  time  five  drops  of  the  tincture  of  belladonna  are 
administered  every  two  hours  until  a  slight  dryness  of  the  pharynx 
is  experienced. 

LOTION. 

R .    Lead  acetate         l 

„       ,       ,    ,  ^  of  each  4  grammes. 

Powdered  alum     j 

Distilled  water    ....    120  grammes.     M. 

Sig.     Externally. 


182  DENTAL  MEDICINE. 

Compresses  moistened  with  this  solution  are  applied  to  the 
affected  parts,  and  renewed  every  two  hours.  It  is  claimed  that 
the  pain  disappears  within  a  few  hours,  and  that  the  disease  is 
considerably  shortened  by  this  treatment. 

Dental  Caries  is  indicated  by  a  process  of  gradual  softening  and 
chemical  disintegration  of  the  tooth  substance,  molecule  by  mole- 
cule, caused  directly  by  micro-organisms  which  attach  themselves 
and  grow  in  contact  with  the  surface  of  the  tooth,  being  pro- 
tected by  a  gelatinous  film,  and  forming  an  acid  which  acts  upon 
the  tooth  tissue,  and  thus  affords  access  to  the  micro-organisms. 
Artificial  coverings  for  the  retention  and  protection  of  the  micro- 
organisms in  contact  with  the  tooth  substance,  may  also  result  from 
badly  performed  technical  procedures,  such  as  imperfect  fillings, 
irregularity  appliances,  gold  bands,  caps,  etc.  The  micro-organ- 
isms have  no  power  of  penetrating  the  enamel  until  its  sub- 
stance is  dissolved  by  their  acid  excretions  making  room  for  them, 
the  lime  salts  of  the  tooth  substance  being  first  dissolved  away  by 
deleterious  agents,  the  progress  being  hastened  by  certain  struc- 
tural defects  in  the  enamel  and  dentine.  Incipient  dental  caries 
is  indicated  by  an  opaque,  whitish  or  gray  appearance  of  the 
enamel.  A  pale  brown  varying  to  a  nearly  black  color  indicates 
the  existence  and  progress  of  dental  caries  in  the  tooth  tissues ; 
the  deeper  the  color  the  slower  the  progress  of  the  caries,  and  the 
paler  the  color  the  more  rapid  the  progress. 

Treatment. — Incipient  caries  should  be  removed  with  great 
care,  and  the  exposed  surface  of  tooth  structure  prepared  to  resist 
further  attacks  by  giving  to  it  as  high  a  polish  as  is  possible,  and 
the  patient  warned  in  regard  to  its  future  cleanliness.  Deep- 
seated  caries  should  be  removed,  and  its  further  progress  arrested 
by  thoroughly  sterilizing  or  disinfecting  the  cavity  by  antiseptics 
and  disinfectants,  and  the  careful  insertion  of  fillings  of  a  durable 
material.  During  pregnancy  all  operations  on  the  teeth  should 
be  painless,  and  long,  wearying  sittings  be  avoided.  Caries  of 
the  teeth  of  pregnant  women  can  be  arrested  by  plastic  fillings 
until  such  time  as  the  patient  can  the  better  endure  more  perma- 
nent operations.  The  preventive  measures  consist  in  the  thor- 
ough  and   frequent   use  of  the  tooth-brush  and   its  adjunct,  floss 


DIAGNOSIS   OF   MOUTH   AFFECTIONS.  183 

silk,  at  least  three  times  a  day,  assisted  by  a  proper  dentifrice  and 
antacid  antiseptic  mouth-wash. 

Calcic  Inflammation  of  the  gums  or  peridental  membrane,  or  of 
both,  is  caused  by  deposits  of  either  salivary  or  serumal  calculi. 
The  tissue  in  contact  with  the  calculus  becomes  hyperemic,  then 
(Edematous,  and  is  kept  in  a  constant  state  of  irritation;  and 
then  inflammation  follows  with  absorption  of  the  pericementum 
and  alveolar  process,  and  looseness  and  loss  of  the  tooth  follows. 

Treatment. — The  calculus  should  be  removed  by  scalers,  and 
the  surfaces  which  it  covers  should  be  smoothed  and  polished  ; 
astringent  and  antiseptic  mouth-washes  will  complete  the  cure. 

Opening  Jbscesses. — Abscesses  moderate  in  size,  will  not  re- 
quire but  one  incision.  In  deep-seated  abscess,  the  method  is  to 
first  incise  skin  and  fascia,  and  then  with  hemostatic  forceps  enter 
the  tissue  until  the  abscess  is  reached,  when  the  handles  are  un- 
locked, and  the  blades  separated,  so  that  on  withdrawing  the  for- 
ceps an  opening  will  be  made  large  enough  to  admit  a  drainage- 
tube  of  the  proper  diameter.  By  such  a  method  danger  of 
injuring  important  vessels  and  nerves  is  avoided.  Alveolar 
abscesses  may  be  opened  by  trephining  the  outer  wall  of  the 
alveolar  cavity  at  the  point  of  suppuration,  and  the  pulp-canals 
rendered  aseptic  to  prevent  a  recurrence  of  the  abscess,  the 
proper  filling  of  the  canals  completing  the  treatment.  The  spray 
of  liquid  air  is  very  beneficial  before  and  after  incision.  (See 
Liquid  Air.) 

Septicemia  is  a  form  of  blood-poisoning  resulting  from  the 
absorption  of  poisonous  (septic)  products.  According  to  Bill- 
roth, septicemia  bears  the  same  relationship  to  surgical  or  trau- 
matic fever  that  pyemia  does  to  suppurative  fever,  each  being  a 
malignant  type  of  the  corresponding  milder  affection, — in  other 
words  a  malignant  form  of  putrid  infection.  It  frequently 
occurs  as  a  complication  of  wounds,  compound  fractures,  gan- 
grenous conditions,  and  especially  in  wounds  with  abundant  dis- 
charges, where  micro-organisms  have  had  free  access  and  a 
process  of  putrefaction  established. 

It  is  characterized  by  such  constitutional  symptoms  as  high 
temperature,  excessive  prostration,  disorders  of  the  nervous  sys- 


1S4  DENTAL  MEDICINE. 


teni,  inflammation  of  internal  organs,  with  typhoid  symptoms, 
and  more  or  less  heart  failure.  The  septic  poisoning  is  due  to 
the  entrance  into  the  blood  of  ptomaines,  certain  forms  of  micro- 
organisms, or  some  ferment-like  substance  possessing  the  power 
of  reproduction,  and  acting  like  the  virus  of  diphtheria  or  tetanus. 
Septicemia  is  classified  as  septic  intoxication,  and  septic  infec- 
tion ;  in  the  first  class  there  is  early  absorption  of  the  products 
of  putrefaction  ;  but  in  the  second  class  the  symptoms  develop 
more  slowly,  and  progressive  changes  occur  which  continue  to  a 
fatal  termination  notwithstanding  all  the  efforts  at  antiseptic 
treatment,  and  is  due  to  the  invasions  of  micro-organisms  into 
the  blood.  The  prominent  symptoms  of  septicemia  are  a  chill, 
followed  by  a  rise  of  temperature  ioi°  to  105°,  nausea,  vomit- 
ing, and  at  times  diarrhoea,  followed  by  delirium  and  coma. 
The  symptoms  depend  upon  the  character  of  the  infecting  or- 
ganisms. 

Treatment. — Both  local  and  constitutional.  The  prophy- 
lactic treatment  consists  in  inducing  an  asceptic  condition 
of  the  wound  and  surrounding  parts  and  the  employment  of 
antiseptics.  Irrigation  with  bichloride  of  mercury  solution,  i  to 
1000,  or  peroxide  of  hydrogen  in  moderate  quantity,  or  carbolic 
acid  solution,  i  to  20,  is  necessary,  and  in  some  cases  curretting 
the  surface  of  the  wound  to  permit  the  remedy  to  reach  deeper 
parts  is  also  required.  The  wound  is  then  packed  with  anti- 
septic gauze,  or  warm  antiseptic  fomentations  may  be  applied  to 
bring  about  free  drainage. 

Saline  purgatives  are  employed  to  eliminate  the  organisms,  and 
the  strength  of  the  patient  maintained  by  quinine  and  stimulants 
until  the  secretory  organs  shall  have  eliminated  the  poison  from 
the  blood.  Tincture  of  digitalis  in  from  5  to  10  drop  doses  is  em- 
ployed for  the  heart  failure,  or  strychnia  in  doses  of  ^V  'o  io  of 
grain  every  two  to  six  hours.  The  diarrhoea  is  to  be  controlled 
by  opium,  or  bismuth  and  tannin. 

Pyemia  or  Septic  Fever  is  a  disease  developed  during  the  process 
of  suppuration  in  wounds  or  the  formation  of  abscesses,  and  is 
induced  by  the  presence  of  pyogenic  micro-organisms  (bacteria) 
in  the  blood.     It  is  accompanied  with  the  formation  of  secondary 


DIAGNOSIS   OF   MOUTH    AFFECTIONS.  1S5 

abscesses  in  various  parts  of  the  body,  which  results  from  the 
invasion  of  micro-organisms  and  their  growth  into  colonies  and 
in  such  a  manner  establishing  independent  centres  of  suppuration. 
It  never  occurs  before  suppuration  has  been  established.  It  is 
caused  by  suppurating  wounds,  and  usually  when  the  formation 
of  pus  is  most  active,  although  it  may  commence  during  any 
stage  of  the  suppurating  process.  Pus  microbes  are  the  active 
cause  of  the  disease,  and  it  is  more  common  to  men  of  middle  age, 
than  to  women,  or  children,  or  even  the  aged.  The  pus  microbes 
cause  the  adhesion  of  the  blood-corpuscles  and  the  formation  of 
thrombi  (or  clots  of  blood  formed  within  the  heart  or  in  blood 
vessels).  The  symptoms  of  pyemia  are  chills,  increase  of  tem- 
perature 104°  to  106°  F.,  ending  in  a  profuse  perspiration,  a  de- 
crease of  temperature  to  normal  or  lower.  The  fever  is  of  an 
irregular,  intermittent  type,  and  the  development  of  secondary 
abscesses  is  indicated  by  febrile  exacerbations,  and  local  inflam- 
matory symptoms.  Swelling  of  the  parotid  gland  with  the  for- 
mation of  metastatic  abscesses  is  sometimes  a  symptom  of  this 
affection.  The  breath  has  a  sweetish,  purulent  odor,  the  pulse 
becomes  weak  and  rapid,  and  the  strength  rapidly  fails.  The 
tongue  becomes  dry  and  brown-coated,  and  the  teeth  and  gums 
are  coated  with  sordes.  Erythematous  patches  appear,  which 
have  a  tendency  to  form  pustules.  The  prognosis  is  verv  un- 
favorable in  acute  cases  of  pyemia. 

Treatment. — The  treatment  is  in  a  great  degree  prophylactic  to 
prevent  suppuration,  and  antiseptic  treatment  is  indicated,  and  the 
wound  rendered  asceptic.  Metastatic  abscesses  must  be  at  once 
opened  and  disinfected.  The  constitutional  treatment  consists  of 
nutritious  and  easily  digested  food,  and  alcoholic  stimulants.  Qui- 
nine in  large  doses  is  often  employed,  and  carbonate  of  ammonium 
and  digitalis  during  the  stage  of  prostration.  Pyemia  resulting  from 
aveolar  abscesses  demands  the  extraction  of  the  affected  tooth 
and  curretting  the  abscess  cavity,  and  after  irrigating  with  anti- 
septic solutions,  the  cavitv  should  be  packed  with  antiseptic  gauze, 
or  iodoform  gauze,  and  this  continued  until  a  healthy  granulating 
surface  is  formed. 

Shock  and  Collapse. — Shock  is  the  depression  of  the  vital  pow- 


186  DENTAL  MEDICINE. 


ers  by  severe  injuries,  surgical  operations,  or  profound  mental 
impressions. 

Collapse  is  a  state  of  nervous  prostration,  and  both  it  and  shock 
have  been  classed  together.  Collapse  arises  from  various  causes 
of  which  shock  may  be  one,  but  shock  may  occur  instantaneously 
in  a  healthy  person,  whereas  collapse  is  generally  manifested  in 
persons  who  have  been  subjected  to  a  prolonged  nervous  strain 
which  has  greatly  exhausted  them.  Prolonged  dental  operations 
depress  the  vital  powers  of  those  already  exhausted  from  disease, 
overwork  of  mind  or  body,  and  sometimes  in  chlorotic  girls, 
pregnant  women,  and  delicate  children  ;  hence,  such  conditions 
should  be  recognized  by  the  dentist,  and  properly  appreciated, 
and  all  operations  of  a  painful  or  prolonged  character  should  be 
avoided,  if  possible,  until  such  times  as  the  improved  condition 
of  the  patient  will  justify  ;  or,  if  imperative,  treatment  which 
will  allay  nervous  irritability  and  prevent  shock,  should  be 
instituted. 

Treatment. — The  patient  should  be  laid  as  flat  on  his  back  as 
possible,  or  even  with  the  head  lower  than  the  rest  of  the  body 
— the  feet  and  extremities  raised.  Some  authorities  recom- 
mend as  a  good  plan  occasionally  to  bandage  the  extremities  from 
their  tip  towards  the  body,  in  order  that  the  blood  they  contain 
naturally  may  be  pressed  to  the  vital  organs.  Should  cyanosis 
occur  it  indicates  that  the  head  is  being  too  much  depressed. 

Warm  stimulating  drinks,  such  as  of  whiskey,  brandy,  etc., 
diluted,  are  serviceable  if  they  can  be  swallowed.  When  the 
patient  cannot  swallow,  almost  as  much  benefit  can  be  gained  by 
resorting  to  enemata  of  hot  coffee  with  brandy,  with  ammonium 
carbonate,  etc.  Nitrite  of  amyl  will  assist  in  equalizing  the  cir- 
culation. The  hypodermic  use  of  strychnia,  and  tincture  of 
digitalis,  will  stimulate  the  activity  of  the  heart.  Failing  respira- 
tion may  be  stimulated  and  sustained  by  atropia  hypodermically 
injected  also.  Care  should  be  exercised  in  giving  strong  liquors, 
for  if  the  patient  cannot  swallow,  some  of  the  irritating  fluid 
may  escape  into  the  larynx,  and  the  coughing  may  be  so  violent 
as  to  prove  fatal  ;  the  same  is  true  of  inhalations  of  strong 
volatile     stimulants.     Reaction     must    not    be    established     too 


INDICATIONS    OF   THE   TONGUE.  187 


quickly.  External  heat  is  often  beneficial,  such  as  the  warm 
bath,  hot  water  bottles  or  bags.  Artificial  respiration  may  also 
be  resorted  to  in  extreme  cases,  or  galvanism — the  Faradic  cur- 
rent to  stimulate  the  diaphragm,  applied  with  one  pole  over  the 
phrenic  nerve,  the  other  over  the  diaphragm.  Small  chips  of  ice, 
made  by  standing  the  piece  with  the  grain  upright,  and  splitting 
off  a  thin  edge  with  the  point  of  a  pin,  if  the  patient  can  swal- 
low them  whole,  will  allay  nausea  and  vomiting  :  also,  if  the 
patient  can  swallow,  twenty  drops  of  aromatic  spirits  of  am- 
monia in  a  little  water  may  be  given  every  two  or  three  minutes, 
until  four  or  five  doses  have  been  taken.  Smelling  salts  (am- 
monia), or  cologne  on  a  handkerchief  may  be  of  service  in  mild 
cases. 

Fainting- Syncope. — Persons  may  often  faint  without  any  per- 
ceptible cause,  but  debility  of  the  nervous  system  favors  it ;  or 
it  may  occur  from  the  sight  of  blood.  In  nervous  patients 
fainting  may  occur  after  severe  hemorrhage,  etc.  The  symptoms 
are  expressionless  face,  pallor  of  skin,  lips,  and  oral  mucous  mem- 
brane, coldness  of  surface  of  body,  irregular  respiration,  breath- 
ing being  irregular  in  rate  and  depth,  dilated  pupils,  mental 
apathy,  loss  of  voluntary  muscle-movement,  and  occasionally 
nausea  and  vomiting. 

Treatment. — The  patient  should  be  placed  in  such  a  position 
that  the  head  will  be  lower  than  the  body  :  if  sitting  in  a  chair 
she  should  not  be  removed  but  the  chair  lowered  backwards,  the 
head  being  supported,  until  the  floor  is  reached.  This  backward 
and  downward  movement  is  readily  made  in  a  dental  chair  by 
lowering  the  movable  back.  Usually  the  consciousness  returns 
as  soon  as  the  head  of  the  patient  is  lowered.  The  dress  should 
be  loosened  about  the  neck  and  chest.  For  an  adult,  a  teaspoon- 
ful  of  brandy  in  a  little  water,  or  twenty  drops  of  aromatic  spirits 
of  ammonia  in  water,  may  be  given  at  short  intervals,  until 
consciousness  and  restored  action  of  the  heart  occurs. 

CHARACTERISTIC    INDICATIONS  OF  THE    TONGUE. 

The  tongue,  when  in  a  normal  condition,  should  be  freely 
movable,  of  a  pink  color,  and   the  dorsum  marked  in  the  centre 


188  DENTAL  MEDICINE. 


by  a  slight  longitudinal  depression  :  a  velvety  appearance,  soft, 
moist  and  vi^arm  to  the  finger ;  the  fungiform  papillae  circular  in 
outline,  and  deeper  pink  than  the  surrounding  surface;  the  cir- 
cumvallate  papillae,  arranged  in  a  V-shaped  row,  having  the  form 
of  an  inverted  cone,  surrounded  by  an  annular  elevation.  Fever 
causes  the  tongue  to  be  frosted  or  coated ;  gastro-intestinal 
affections  are  attended  by  coating  of  the  tongue,  and  the  various 
appearances  of  this  coating  are  of  important  diagnostic  and 
therapeutic  significance.  Inflammation  reddens  the  mucous 
membrane  and  makes  it  hot  and  tender,  increases  its  moisture, 
changes  the  surface  of  the  tongue,  and  causes  the  formation  of 
aphthae,  ulceration,  and  even  gangrene.  In  aphthous  stomatitis 
the  edges  of  the  tongue  are  clean  and  red,  while  its  dorsum  is 
covered  with  a  thick  white  coating.  In  ulcerative  stomatitis  the 
tongue,  besides  presenting  the  marginal  ulcers,  is  swollen  and 
heavily  coated  with  a  dirty,  yellowish  white  fur.  In  thrush  the 
mucous  membrane  is  covered  with  white,  curd-like  flakes,  due  to 
the  development  of  the  parasite  oidium  albicans.  Prior  to  the  ap- 
pearance of  the  flakes  the  mucous  membrane  is  purplish-red  and 
sticky,  and  its  secretion  acid  in  reaction.  In  severe  neuralgia  on 
one  side  of  the  face,  the  tongue  presents  an  unilateral  furring, 
thickening  of  the  mucous  membrane,  or  enlargement  of  the 
papillae.  Acute  or  chronic  alcoholism  causes  a  tremulous  and 
foul  tongue.  Migraine  causes  a  much  furred  surface  of  the 
tongue.  When  paralyzed,  the  tongue  presents  the  appearance 
of  a  sodden  mass  lying  in  the  mouth  ;  in  chorea  its  movements 
are  jerking  and  irregular;  in  cerebral  disease,  the  tongue  shows 
a  tendency  to  become  thickly  furred,  and  very  foul,  especially  in 
apoplexy  due  to  hemorrhage.  Allowance,  however,  must  always 
be  made  for  individual  peculiarities,  in  shape  and  size  of  the 
tongue,  as  also  appearance,  for  effects  of  certain  habits,  such  as 
excessive  smoking  or  chewing  tobacco,  etc.,  taking  iron,  or  other 
medicines,  or  for  any  local  irritation.  In  some  individuals  the 
surface  of  the  tongue  presents  constantly  a  thick  fur  without  dis- 
turbance of  organs  or  appetite,  while  on  the  other  hand,  a  per- 
fectly clean  and  healthy-looking  tongue  may  be  associated  with 
severe  dyspeptic  symptoms  or  serious'  alimentary  trouble.     The 


INDICATIONS   OF   THE   TONGUE.  189 

common  appearances  of  the  tongue  are  supposed  to  indicate  the 
following  conditions  : 

A  White  Coated  Tongue  indicates  febrile  disturbance. 

A  Brown  Moist  Tongue  indicates  digestive  disorder  and  an 
overloaded  stomach. 

A  Brown  Dry  Tongue  indicates  depressed  vital  power. 

A  Red  Moist  Tongue  indicates  feebleness,  especially  from  ex- 
haustive discharges. 

A  Red  Dry  Tongue  indicates  inflammatory  fever  or  pyrexia. 

A  Red  Glazed  Tongue  indicates  debility  and  inability  to  di- 
gest food  and  stimulants. 

A  Tremulous,  Moist  and  Flabby  Tongue  indicates  feebleness 
and  nervousness. 

A  Glazed  Bluish  Tongue,  with  loss  of  epithelium  in  patches, 
and  in  severe  cases,  cracks  and  scars,  indicates  tertiary  sypJiilis. 


DENTAL  MATERIA   MEDICA 

AND 

THERAPEUTICS. 


ACACIA — GUM    ARABIC. 


Source. — A  thorny  tree  or  shrub,  of  Arabia  and  Africa. 

Description. — The  concrete  juice  which  exudes  spontaneously 
from  the  stem  of  the  Acacia  vera,  in  the  form  of  a  gum,  which 
hardens,  on  exposure,  in  small,  irregular  or  roundish  or  oval 
pieces,  of  various  sizes,  more  or  less  transparent,  hard,  brittle 
and  pulverizable.  It  is  generally  either  white  or  yellowish-white, 
but  sometimes  of  a  deep  orange  or  brownish  color;  the  powder, 
however,  being  pure  white.  It  is  inodorous,  with  a  feeble, 
slightly  sweetish  taste,  and  when  pure  dissolves  wholly  away  in 
the  mouth. 

In  water  it  forms  a  viscid  solution,  known  as  mucilage. 

It  is  insoluble  in  alcohol,  ether  and  the  oils.  When  kept  dry 
it  undergoes  no  change. 

Chemical  Constituents. — It  consists  of  a  peculiar  proximate 
principle  known  as  Gum  or  Jrabin^  composed  chiefly  of  a  soluble 
acid  substance,  Gummic  Acid  (H2Ci2Hi^OioH20),  combined  with 
3  per  cent,  of  lime,  forming  a  soluble  salt,  gummate  of  calcium. 

Medicinal  Properties  and  Action. — Demulcent  and  emollient. 
It  forms  an  excellent  adjunct  to  other  medicinal  substances  of 
the  same  class,  and  an  ingredient  in  all  the  officinal  lozenges. 

Dose. — Of  the  gum,  ,^j  ad  libitum.  Of  the  mucilage  (siv, 
water  .5vj)  ,5ij  to  .^vj  daily,  or  ad  libitum. 

Therapeutic  Uses. — Coughs  and  hoarseness,  gastro-intestinal 
irritation,  infantile  diarrhoea,  epistaxis  and  superficial  hemor- 
rhages :   applied  in  the  form  of  fine  powder. 

Dental    Uses. — As  an   emollient   in   the    form   of  mucilage,  to 
cover  and  protect  inflamed  surfaces  of  mucous  membrane. 
190 


ANTIFERBRIN.  191 


As  a  mechanical  styptic,  in  a  finely-powdered  form,  in  super- 
ficial hemorrhages,  such  as  from  leech  bites,  etc. 

Combined  with  borax,  it  is  a  useful  application  for  inflamed 
mucous  membrane. 

Prof.  Bonafoux,  of  the  Academy  of  Medicine,  Paris,  recom- 
mends a  powder  composed  of  equal  parts  of  gum  arabic,  colo- 
phony and  carbon,  as  possessing  great  hemostatic  powers,  and 
capable  of  arresting  the  bleeding  of  large  arteries. 

DENTAL    FORMULA. 
For  Inflamed  Mucous  Surfaces. 

U  Pulveris  acacia 2;  ij 

Sodii  boratis gij 

Fiat  pulvis. 
SiG. — Apply  to  inflamed  part. 

h.QY.i:K^\\AV>—PHEXYL-ACETAMIDE  (ANTIFEBRIN). 

Formula.— Q^^O  or  CgH^N  (C2H30)H. 

Derivation. — Acetanilide  is  a  derivative  of  aniline,  made  by 
adding  an  excess  of  glacial  acetic  acid  to  pure  colorless  analine. 
It  is  in  the  form  of  a  white  crystalline  powder  of  neutral  reaction, 
without  odor  or  disagreeable  taste,  slightly  pungent,  producing  a 
burning  sensation  when  applied  to  the  tongue.  It  resembles 
"  mother  of  pearl  "  when  evaporated  by  heat,  in  thq  form  of  large 
scales.  It  is  but  slightly  soluble  in  cold  water,  but  freely  soluble 
in  ether,  chloroform  and  alcoholic  solutions.  It  is  not  altered  by 
acids  or  alkalies.  The  pure  drug  should  be  white  or  of  a  faint 
rose-tint,  and  should  form  a  colorless  liquid  and  completely  vola- 
tilize when  heated  upon  a  platinum  surface.  Water  of  a  tem- 
perature of  105°  F.  will  dissolve  one  part  of  it  to  fifty  of  the 
water ;  alcohol,  from  3  to  5  parts,  and  ether  and  chloroform  in 
larger  proportions. 

Medical  Properties  and  Physiological  Action. — Acetanilide  is  an- 
tipyretic, diuretic,  antiperiodic  and  anodyne,  and  in  ordinary  doses 
its  action  is  less  marked  on  healthy  persons  than  when  fever  is 
present,  as  its  most  apparent  action  is  to  reduce  temperature  by 
converting  oxyhemoglobin  into  methemoglobin  in  the  red  blood- 
corpuscles  interfering  with  oxidation.     When  an  excessive  quan- 


192  DENTAL  MEDICINE. 


tity  is  absorbed,  the  alkalinity  of  the  blood  is  reduced,  the  red 
corpuscles  destroyed,  the  hemoglobin  liberated  and  appearing  in 
the  urine,  which  is  changed  to  a  dark-brown  color.  It  increases 
the  quantity  of  uric  acid  and  urea  present  in  the  urine.  Large 
doses  may  cause  diastolic  arrest  of  the  heart,  preceded  by  motor 
and  sensory  paralysis.  Small  doses  increase  the  action  of  the 
skin  and  kidneys.  The  blood-pressure  at  first  increases,  but 
soon  falls,  and  the  heart's  action  becomes  slower.  It  is  contrain- 
dicated  in  large  doses  in  the  low  fevers,  owing  to  its  action  on 
the  blood  cells.  It  is  eliminated  by  the  kidneys.  Belonging  to 
the  aromatic  series  of  antipyretics,  derived  from  coal  tar,  it  pos- 
sesses advantages  over  all  the  others  from  the  same  source.  In 
some  cases  toxic  effects,  ascribed  to  impurity,  or  peculiar  suscep- 
tibility to  its  action,  have  resulted  from  its  administration  ;  cyan- 
osis and  collapse  also  have  occurred,  as  well  as  vomiting  and 
profuse  perspiration.  Such  ill  effects  from  acetanilide  must  be 
counteracted  by  the  application  of  external  heat,  vigorous  alco- 
holic stimulation,  with  hypodermic  use  of  ether,  atropine,  and 
strychnine,  in  order  to  support  the  respiration  and  circulation. 
Acetanilide  is  much  used  for  headache,  neuralgia,  rheumatism, 
facial  neuralgia,  locomotor  ataxia,  sciatica;  in  acute  inflammatory 
rheumatism  it  reduces  the  temperature,  relieves  the  pain  and 
swelling.  It  is  also  used  in  croupous  pneumonia,  scarlatina  and 
other  febrile  affections  of  children. 

It  relieves  any  tendency  to  nausea  and  vomiting,  and  is  usually 
tolerated  by  a  weak  stomach.  On  account  of  its  diuretic  action 
acetanilide  is  especially  harmless  in  kidney  affections.  Antidotes, 
— emetics  and  stimulants. 

Dose. — The  dose  varies  from  grs.  ijss,  repeated  every  hour,  to 
grs.  X  every  three  or  four  hours ;  it  may  be  given  in  the  form  of 
pill,  powder  or  tablet  triturate.  Its  prolonged  use  causes  it  to 
lose  its  effect ;  but  its  action  is  renewed  if  the  drug  is  withheld 
for  24  or  48  hours. 

Dental  Uses. — Acetanilide  is  employed  in  dental  practice  for 
facial  neuralgia,  pulpitis;  internally  administered  in  connection 
with  the  application  of  the  devitalizing  mixture  to  relieve  the 
pain  of  the  latter,  in  doses  of  two  and  one-half  grains,  repeated 


ACETIC   ACID. 


193 


every  hour  until  ten  grains  have  been  taken ;  also  for  the  relief 
of  the  pain  of  periodontitis  and  alveolar  abscess,  etc.,  etc. 
For  periodontitis,  first  paint  the  gum  near  affected  root  with 
tincture  of  aconite  and  tincture  of  iodine,  tincture  of  cannabis 
indica,  and  comp.  tincture  of  benzoin,  equal  parts,  then  apply 
a  capsicum  plaster  to  gum,  and  administer  two  and  one-half  grains 
of  acetanilide;  repeat  the  acetanilide,  if  necessary,  every  two 
hours  until  ten  grains  are  taken.  In  facial  neuralgia,  periodon- 
titis, etc.,  it  has  proved  effectual  in  cases  where  quinine  has 
failed,  or  has  been  contraindicated. 

Formalide. — Antiseptic  and  Germicide.  It  is  composed  of 
acetanilide  y^  per  cent.,  formaldehyde  ^  per  cent.,  boroglyceride 
I  per  cent.,  sodium  benzo-borate  2  per  cent.,  with  eucalyptol, 
thymol,  menthol,  oil  gaultheria,  alcohol  and  witch-hazel. 


For     Facial     A'euralgia,     A^euralgic 
Headache,  Acute  Periodontitis,  etc. 


DENTAL    FORMULA. 

For  Simple  Fevers  of  Children. 
Dr.  Hollopeter. 


Dr.  Shoemaker. 

R.     Acetanilide gr.ioo 

Lupulini gr.ioo  M. 

Ft. — CapsuIre'No.  xx. 
SiGNA. — One  or  two  capsules  every  2 
or  3  hours. 

For  Pain  of  Pericementitis. 


Dr.  a.  W.  Harlan. 


R 


Acetanilide     .    .    .    .  gr.  viij 
Syr.  simple     .    .    .    .  ^ij 
Spir.  Frumenti  .    .    .  ^  ij  M. 

Signa, — One-half  of  the  above  at  one 

time,  followed  in  5  hours  by  the  other 

half. 


.  gr.xviij 

■  gi--xij 
.  gr.xv 


R.     Acetanilide    .... 
Hydrarg.  chlor.  mitis 
Sodii  bicarb.      .    .    . 

Sacch.  lact 

M.  Ft. — Chart  No.  xij. 
Signa. — One  every  2  hours  until  3  are 
taken. 

A     Convenient   Prescription   for  Ace- 
tanilide {Antefebrine). 

Dr.  E.  L.  Clifford. 

R.     Acetanilide ^j 

Sp.  vini  gallici    .    .    .   ^  iv.ss 

Syr.  simple 

Aquae aa,!5vj  M. 

Signa. — A    tablespoonful    contains   5 
grains,  an  adult  dose. 


ACIDUM  ACETICUM— ACETIC  ACID. 
Formula. — CgH^O,,  or  conveniently  written  HC,  H3O2. 
Derivation. —  Purified  Pyroligneous  Acid.      Prepared  from  wood 
by  destructive   distillation  ;  contains   28   per  cent,  of  anhydrous 
acetic  acid.     Specific  gravity,  1.047. 
13 


194:  DENTAL  MEDICINE. 


Dilute  Acetic  Acid — Ac'idum  Acetkum  Dilutum^  the  only 
form  in  which  it  is  employed  internally,  is  prepared  by  mixing 
one  pint  of  acetic  acid  with  seven  pints  of  distilled  water. 
Specific  gravity,  1.006. 

Medical  Properties  and  Action. — Refrigerant,  diaphoretic,  astrin- 
gent, diuretic,  stimulant,  tonic.  It  allays  restlessness  by  allaying 
thirst,  and  acts  upon  the  skin  and  kidneys;  also  acts  as  an  anti- 
scorbutic. The  strong  acid  applied  to  the  skin  causes  intense 
redness  and  pain,  followed  by  rapid  vesication. 

Dose. — Of  acetic  acid,  gtt.  iij  to  x.  Of  dilute  acetic  acid,  5j 
to  ij. 

Therapeutic  Uses. — Fevers,  night  sweats,  diarrhoea,  scurvy, 
hemorrhage  of  the  lungs,  stomach  and  nose.  Externally  the 
strong  acetic  acid  is  applied  in  tinea  capitas,  psoriasis,  cancer, 
corns  and  warts  ;  the  dilute  form  is  applied  externally  to  gan- 
grene, ulcerated  throat,  in  the  form  of  gargle,  ulcers,  sprains  and 
bruises.  Owing  to  its  volatility  and  pungency,  its  vapor,  when 
applied  to  the  nostrils,  acts  as  an  excitant  in  syncope,  headache, 
etc. 

Dental  Uses. — Acetic  acid  is  externally  employed  in  indolent 
ulcers  of  the  mouth,  cancrum  oris  and  scurvy,  both  locally  and 
internally.  It  is  also  applied  to  fungous  growths  of  gums  and 
dental  pulps,  the  stronger  acid  being  used.  In  the  form  of  a 
gargle  it  is  used  for  inflamed  conditions  of  the  mouth  and  fauces. 
In  the  form  of  glacial  acetic  acid — Acidum  Aceticum  Glaciate  (con- 
centrated acetic  acid),  it  is  applied  externally  as  a  caustic  in  fun- 
gous growths  of  gum,  dental  pulp,  etc.  In  cancerous  ulcerations 
of  mucous  membrane,  it  relieves  pain  and  promotes  a  healthier 
condition. 

DENTAL    FORMULA. 

For   Indolent    Ulcers    of  the   Mouth, 

,^  /^   •     r-  For  Inflamed  Fauces. 

Cancrum   Oris,  ticurvy.  ■' 

R.     Acidi  acetici ^  3'J  R-     Acidi  acetici f  ^'j 

Aquae ^^^  Ammonii  cliloridi      ...     5  j 

Fiat  solution.  Mellis     .    .    .    .     •   .    .    .  f  ^iss 

SiGNA. — Apply    with    a    camel's-hair  Aqua; f  S^ij 

brush.  Fiat  gargarysma. 


ARSENIOUS   ACID.  I95 


ACIDUM  ARSENIOSUM— ARSENIOUS  ACID. 
WHITE    OXIDE    OF    ARSENIC ARSENIOSUM    OXIDUM. 

Formula. — AS2O3. 

Arsenic-Arsenicum,  the  metal  from  which  arsenious  acid  is 
obtained,  is  not  employed  as  a  medicine  in  its  native  state.  It  is 
combined  with  sulphur  and  certain  metals,  and  is  hard,  brittle, 
crystalline,  of  a  steel-gray  color.  When  heated  to  a  dull  red- 
ness, it  volatilizes  in  the  form  of  a  colorless  vapor,  with  an  odor 
like  that  of  garlic — alliaceous.  It  is  generally  found  in  cobalt 
ore.     It  is  a  powerful  poison. 

Derivation. — Arsenious  Acid  is  obtained  by  roasting  arsenical 
ores,  and  purifying  by  sublimation.  It  is  in  the  form  of  a  fine 
white  powder,  which  is  often  adulterated  with  chalk,  lime,  etc. ; 
hence  it  is  better  to  procure  it  in  the  solid  form  or  lump,  which 
is  of  a  milk-white  color  externally,  and  often  perfectly  transpar- 
ent internally.  It  has  no  odor,  and  is  therefore  liable  to  be  mis- 
taken for  more  innocent  substances,  and  scarcely  any  taste,  or 
merely  a  faint,  sweetish  impression. 

Medical  Properties  and  Action. — Arsenious  Acid  in  large  doses 
is  a  virulent  irritant  poison,  but  in  doses  of  one-sixtieth  to  one- 
twelfth  of  a  grain,  properly  administered,  is  a  tonic  increasing 
the  appetite  and  improving  the  secretions,  both  in  quality  and 
quantity.  In  large  doses,  in  the  form  of  Fowler's  Solution — 
Liquor  Potassii  Jrsenitis  (prepared  by  boiling  64  grains  of  arsen- 
ious acid  and  bicarbonate  of  potassium,  each  in  half  a  fluid  ounce 
of  distilled  water,  then  adding  12  fluid  ounces  more  of  distilled 
water,  half  a  fluid  ounce  of  compound  spirit  of  lavender,  and 
afterwards  water  enough  to  make  the  solution  measure  a  pint) — it 
is  a  powerful  antiperiodic.  In  small  doses,  administered  for  a 
considerable  time,  it  modifies  the  blood,  and  through  it  nutrition, 
so  as  to  remove  various  morbid  conditions.  When  continuously 
used,  a  sensation  of  heat  in  the  throat,  oesophagus  and  stomach 
is  sometimes  experienced,  nausea,  pain  in  the  stomach  and  occa- 
sional vomiting  ;  also,  great  languor  or  depression  of  spirits,  with 
redness  of  the  eyes,  swelling  of  the  eyelids  and  oedema  of  the 
face ;  hence,  at  the  first  evidence  of  such  symptoms,  the  remedy 
should   be  discontinued  until   they  have  passed   away.     When 


196  DENTAL  MEDICINE. 


continually  increasing  doses  are  administered,  the  arsenic  accumu- 
lates, and  poisonous  symptoms  quickly  appear ;  hence,  it  is  rec- 
ommended to  begin  a  course  of  arsenic  with  large  doses,  and  the 
quantity  given  regularly  reduced.  When  arsenious  acid  is  ad- 
ministered, the  bowels  should  be  well  evacuated  by  a  purgative, 
given  previously,  and  the  arsenic  taken  directly  after  a  meal,  but 
never  upon  an  empty  stomach,  on  account  of  gastric  irritation. 
Its  use  should  be  omitted  for  a  day  or  two  every  two  or  three 
weeks,  and  a  mild  aperient  employed,  in  order  to  prevent  the  ac- 
cumulation of  the  arsenic  in  the  system.  A  few  drops  of  laud- 
anum added  to  the  arsenical  preparation  will  prevent  nausea  and 
vomiting.  All  arsenical  preparations  should  be  administered  with 
the  greatest  regularity,  at  stated  times. 

During  the  employment  of  arsenic,  the  eyes  of  the  patient 
should  be  examined  daily,  and  if  the  eyelids  and  conjunctiva  be- 
come inflamed,  the  remedy  should  be  discontinued ;  also,  when 
the  urine,  from  being  pale  and  copious,  becomes  scanty,  acid  and 
high-colored,  the  arsenic  should  be  suspended. 

Poisonous  symptoms  have  been  caused  by  half  a  grain  of  arsen- 
ious acid,  and  fatal  effects  have  followed  the  administration  of  two 
grains,  although  much  larger  quantities  have  been  taken  with  im- 
punity ;  very  large  quantities  often  cause  emesis,  which  removes 
the  substance  frdm  the  stomach,  and  thus  prevents  fatal  effects. 
When  the  idiosyncrasies  of  the  patient  are  unknown,  it  is  better 
to  use  small  doses  before  beginning  with  large  doses.  The 
quantity  of  arsenic  required  to  produce  a  fatal  effect  varies  ac- 
cording to  the  susceptibilities  of  the  patient  and  the  state  of  the 
stomach.  Much,  however,  depends  on  the  idiosyncrasies  of  the 
individual,  which  differ  greatly  in  different  persons.  When  large 
quantities  are  taken,  the  effects  are  sometimes  manifested  on  the 
cerebro-spinal  system,  death  following,  from  narcotism,  in  a 
short  time. 

The  amount  of  arsenious  acid  which  may  be  safely  introduced 
into  the  stomach  should  never  be  equaled  in  an  application  to  the 
pulp  of  a  tooth.  One-twentieth  of  a  grain  may  be  a  safe  dose 
medicinally,  but  a  much  less  quantity  is  sufficient  for  devitalizing 
the  pulps  of  teeth. 


ARSENIOUS    ACID.  I97 


When  arsenious  acid  is  swallowed  or  applied  to  a  denuded  sur- 
face, it  is  rapidly  absorbed  into  the  system ;  hence  it  is  a  danger- 
ous agent,  and  in  every  case  it  should  be  carefully  used,  and  its 
effects  closely  watched.  It  possesses  a  very  powerful  antiseptic 
property,  arresting  the  process  of  putrefaction.  The  stomach 
and  alimentary  canal  of  persons  who  have  died  from  its  effects 
have  been  found  in  a  perfect  state  of  preservation  for  a  long  time 
after  interment. 

Poisonous  doses  produce  great  intestinal  inflammation,  with 
ulceration  in  some  cases,  and  rarely,  gangrene.  It  has  also  been 
detected  after  death,  in  the  blood,  in  the  urine,  and  also  in  the 
liver,  spleen,  kidneys,  muscles  and  stomach.  A  certain  degree 
of  tolerance  in  the  use  of  arsenic  may  be  established,  when 
poisonous  doses  can  be  taken  with  impunity.  Such  a  state  may 
be  produced  by  the  constant  legitimate  use  of  the  agent,  or  in  the 
case  of  those  who  begin  the  habit  of  arsenic  eating  at  an  early 
age,  and  who  find  this  practice  of  service  in  increased  breathing 
power,  strength,  and  improved  bodily  condition.  As  long  as  such 
a  habit  is  continued,  no  ill  effects  are  apparent ;  but  as  soon  as  the 
arsenic  is  discontinued,  symptoms  resembling  those  of  poisonous 
doses  make  their  appearance. 

Arsenious  acid  acts  locally  as  an  escharotic,  but  while  a  true 
escharotic  acts  chemically,  producing  decomposition  of  the  part 
to  which  it  is  applied,  a  state  incompatible  with  life,  arsenic 
destroys  the  vitality  of  the  organized  structure,  and  its  decompo- 
sition is  the  consequence.  This  distinction  should  be  remem- 
bered in  the  use  of  arsenious  acid  in  dental  practice. 

Arsenic  is  eliminated  by  the  liver,  kidneys,  intestinal  canal  and 
bronchial  tubes;  and  it  is  thought  that  some  of  the  symptoms 
produced  by  it  have  their  origin  in  the  local  effects  of  the  poison 
on  the  channels  of  excretion. 

The  symptoms  of  gastro-intestinal  arsenical  poisoning — the 
more  common  form — are  described  by  Bartholow  as  follows: 
Burning  sensation  at  the  epigastrium,  and  extending  over  the 
abdomen  ;  violent  and  uncontrollable  vomiting ;  excessive  dryness 
of  the  mouth  and  fauces,  intense  thirst,  intestinal  irritation, 
bloody  and   offensive   stools,  retracted   abdomen,  strangury,  sup- 


198  DENTAL  MEDICINE. 


pression  of  urine,  or  bloody  urine,  and  in  females  menorrhagia ; 
rapid  and  feeble  action  of  the  heart,  oppressed  breathing,  great 
agitation  and  restlessness,  shrunken  features,  cold  breath,  involun- 
tary evacuations,  collapse  ;  consciousness  being  retained  to  the  end. 

The  symptoms  of  the  cerebral  form  of  arsenical  poisoning  are 
profound  insensibility  and  coma,  similar  to  extreme  opium 
narcosis.  The  effects  of  arsenical  poisoning,  when  not  fatal,  are 
felt  for  a  long  time  in  the  form  of  gastro-enteric  irritability,  an 
irritable  condition  of  the  skin,  stiffness  of  the  joints,  neuralgic 
pains,  numbness,  formication,  paralysis,  etc. 

After  death  from  arsenical  poisoning,  the  gastro-intestinal 
mucous  membrane  exhibits  deep  redness,  erosions,  ecchymosis 
and  softening.  Death  generally  occurs  in  the  midst  of  convul- 
sions, followed  by  rigid  spasm  of  the  whole  body. 

When  arsenic  has  been  injudiciously  administered  for  too  long 
a  period,  in  addition  to  the  irritation  of  the  conjunctiva,  swelling 
of  the  face,  desquamation  of  the  skin,  etc.,  salivation  has  been 
observed  in  some  instances,  and  at  times  a  peculiar  silvery  white- 
ness of  the  tongue. 

Dose. — Of  arsenious  acid,  gr.  ^^  to  gr,  J^,  in  pills  with  bread 
crumb  three  times  a  day.  Of  liquor  potassii  arsenitis  (Prowler's 
Solution),  Itlij  to  Hlx,  three  times  a  day ;  each  fluid  drachm  con- 
tains half  a  grain  of  arsenious  acid. 

Arsenic  is  contraindicated  in  infancy  and  childhood ;  in  all 
sthenic  diseases  accompanied  by  strong  arterial  action  ;  in  all 
irritable  conditions  of  the  stomach  and  alimentary  canal ;  and  in 
all  inflammatory  and  pulmonary  affections. 

Therapeutic  Uses. — In  intermittent  and  periodic  diseases,  such 
as  malaria,  neuralgia  and  spasmodic  affections,  being  of  great 
value  in  neuralgia,  especially  when  of  a  malarial  type,  hemicrania, 
chronic  rheumatism,  asthma,  whooping-cough,  chorea,  diseases 
of  the  skin,  vomiting  of  pregnancy,  hay  fever,  irritative  dyspepsia, 
uterine  affections,  bites  of  venomous  snakes,  etc.  Externally  it 
is  applied  to  cancerous  growths ;  hypodermically,  in  cases  of 
local  chorea. 

Arsenic  is  also  employed  medicinally  in  the  forms  of  arseniate 
of  iron  (Ferri  Arsenias)  and  arseniate  of  soda  {Soda  Jrsenias). 


ARSENIOUS   ACID.  I99 


Dental  Uses. — The  devitalizing  power  of  arsenious  acid  being 
far  more  powerful  than  its  escharotic  power,  it  has  been  em- 
ployed for  many  years  to  destroy  the  vitality  of  the  pulps  of 
teeth,  for  which  purpose  it  is  generally  combined  with  either  the 
acetate  or  sulphate  of  morphia  and  sufficient  creasote  to  form  a 
paste,  to  prevent,  or  at  least  mitigate,  the  extremely  painful  action 
of  the  arsenic  when  topically  applied  to  living  tissue.  It  was  for- 
merly supposed  that  creasote  was  a  solvent  for  the  arsenic,  but  this 
is  now  denied.     Carbolic  acid  may  be  substituted  for  the  creasote. 

As  the  danger  of  absorption  is  great,  there  is  considerable  risk 
in  applying  arsenious  acid  to  the  teeth  of  young  persons,  or  those 
very  susceptible  to  the  influence  of  this  agent ;  hence  other 
escharotics,  such  as  repeated  applications  of  carbolic  acid,  or 
pepsina  porci,  with  dilute  hydrochloric  acid,  or  nitric  acid, 
chromic  acid,  or  chloride  of  zinc,  or  the  galvanic  cautery,  or  the 
surgical  method  of  introducing  into  the  body  of  the  pulp  a 
barbed  wire,  are  employed  in  such  cases.  The  arsenious  acid, 
when  employed  for  the  devitalization  of  dental  pulps,  has  been 
combined  with  pulverized  charcoal,  under  the  impression  that  the 
latter  prevents  the  rapid  absorption  of  the  arsenic,  and  thus  limits 
its  action  mechanically  rather  than  therapeutically. 

The  creasote  (or  carbolic  acid),  employed  in  combination  with 
the  arsenious  acid  as  a  nerve  paste,  obtunds  sensibility,  acting  as 
a  styptic,  antiseptic  and  escharotic  ;  hence  some  depend  upon 
this  agent  alone  to  modify  the  action  of  the  arsenic,  and  dispense 
with  the  morphine. 

Tannic  acid  and  tincture  of  aconite  are  sometimes  substituted 
for  the  morphine  and  creasote,  or  carbolic  acid  in  the  preparation 
of  a  nerve  paste.  Arsenious  acid  is  also  employed  alone,  in  the 
form  of  a  dry  powder,  to  devitalize  pulps  of  teeth  ;  but  it  is  not 
only  more  painful,  but  less  prompt  in  its  action  than  when  it  is 
combined  with  other  agents.  Previous  to  the  application  of  the 
arsenical  preparation,  chloroform,  tincture  of  aconite,  sulphate 
of  atropine,  cocaine,  etc.,  may  be  applied  to  the  exposed  portion 
of  the  pulp,  and  the  painful  effect  of  the  arsenic  be  thus  modi- 
fied. The  spray  of  rhigolene,  or  absolute  ether,  has  also  been 
employed  for  this  purpose. 


200  DENTAL  MEDICINE. 


The  quantity  of  arsenious  acid  to  be  employed  for  devitali- 
zation will  depend  upon  the  structure  and  class  of  the  tooth, 
varying  from  the  jU-,  z^-,  A  to  the  ^V  o(  a  grain  ;  also  the  length 
of  time  the  arsenical  preparation  should  remain  in  the  tooth,  as 
the  condition  of  the  pulp  and  tooth,  the  age  of  the  patient,  the 
quality  of  the  tooth  structure  and  the  susceptibility  of  the  patient 
should  all  be  considered.  While  in  most  cases  pulps  are  readily 
devitalized  by  the  application  of  a  moderate  quantity  of  the 
agent,  in  other  cases  it  appears  to  be  impossible  to  accomplish 
this  object  without  extra  measures  are  resorted  to.  In  teeth  of  a 
soft,  frail  structure,  owing  to  an  excess  of  organic  matter,  the 
arsenic  is  rapidly  absorbed ;  but  if,  on  the  other  hand,  the  tooth 
is  of  a  dense  structure,  the  retention  of  the  arsenical  preparation 
for  a  much  longer  time  may  not  be  attended  with  any  injurious 
effects,  such  as  peridental  inflammation.  From  twelve  to  twenty- 
four  hours  are  generally  required  to  enable  the  arsenious  acid  to 
properly  devitalize  the  pulp  of  a  tooth ;  the  difference  in  time 
depending  upon  the  quantity  of  the  acid  employed,  as  well  as 
upon  other  circumstances  already  enumerated.  To  produce  a 
speedy  effect,  the  pulp  should  be  freely  exposed  by  the  careful 
application  of  the  excavator,  and  the  devitalizing  agent  applied 
directly  to  the  exposed  surface  of  the  organ.  Accuracy  as  to 
the  quantity  of  the  arsenious  acid  to  be  employed  may  be  arrived 
at  by  having  a  grain,  in  the  form  of  the  dry  powder,  divided  into 
forty,  sixty,  or  one  hundred  parts.  A  pellet  of  cotton,  on  the  end 
of  an  excavator,  may  then  be  saturated  with  creasote  or  carbolic 
acid  or,  what  may  be  more  painless,  oil  of  cloves,  and  the  desired 
quantity  of  the  powder,  being  taken  up  on  the  pellet,  can  be 
placed  directly  in  contact  with  the  exposed  surface  of  the  pulp, 
and  secured  in  the  carious  cavity  by  means  of  a  second  pellet  of 
cotton,  saturated  with  either  sandarach  or  shellac  varnish,  a  solu- 
tion of  gutta  percha  and  chloroform,  wax,  or  softened  gutta 
percha.  To  properly  secure  the  arsenical  preparation  in  the 
cavity  of  a  tooth,  a  concave  disk  of  thin  platinum  may  be  placed 
over  it,  and  a  temporary  filling  of  soft  gutta  percha,  or  oxy- 
phosphate  of  zinc,  introduced  into  the  carious  cavity.  Many 
condemn  the  use  of  sandarach  or  other  varnish  to  seal  the  arsenic 


ARSENIOUS   ACID.  201 


into  cavities,  preferring  a  filling  of  denser  material,  such  as  soft- 
ened gutta  percha,  chloro-percha  and  cotton,  zinc  cement,  etc., 
to  confine  the  arsenic  more  securely. 

Dr.  Chas.  Truman  suggests  a  mixture  of  iodoform  and  arsen- 
ious  acid  as  a  painless  devitalizer  under  all  conditions.  It  is  ap- 
plied as  follows :  After  placing  the  rubber  dam  in  position,  dry- 
ing cavity,  etc.,  the  amount  of  the  arsenious  acid  it  is  proposed 
to  employ  is  placed  upon  a  glass  slide  and  an  equal  quantity  of 
iodoform,  or  an  excess  is  added  and  a  paste  made  with  a  five  per 
cent,  solution  of  carbolic  acid,  and  the  whole  carried  to  the  pulp 
on  a  piece  of  cotton,  the  size  of  a  pin's  head.  This  is  then 
covered  with  a  gutta  percha  cap,  or  one  of  platinum,  and  a  tem- 
porary filling  introduced ;  the  latter  may  consist  of  softened  gutta 
percha  or  zinc  filling  material.  Pressure  upon  the  pulp  must  be 
avoided. 

Some  prefer  to  wound  the  pulp,  so  as  to  draw  blood,  before 
the  application  of  the  arsenical  preparation  is  made,  and  thus 
insure  its  speedy  action.  Care  is  necessary  that  the  arsenic 
should  be  completely  secured  in  the  carious  cavity,  and  no  por- 
tion of  it  come  in  contact  with  the  parts  outside  of  the  tooth. 
In  the  case  of  proximal  cavities,  a  roll  of  bibulous  paper,  saturated 
with  sandarach  varnish,  may  be  pressed  between  the  teeth,  be- 
yond the  cavity,  and  thus  prevent  the  arsenical  preparation  from 
coming  in  contact  with  the  gum  and  cheek,  or  gutta  percha  may 
be  softened  and  packed  against  the  margin  of  the  gum  in  such  a 
quantity  as  will  fill  the  interspace.  Failure  to  observe  such  pre- 
cautions may  result  in  violent  inflammation  involving  the  alveoli 
and  causing  necrosis  of  the  bone.  After  the  devitalization  of  the 
pulp  has  been  accomplished,  it  is  necessary  that  every  particle  of 
the  arsenic  should  be  removed  from  the  tooth.  The  effect  of 
permitting  the  agent  to  remain  in  the  tooth  for  a  longer  time  than 
is  necessary  for  the  devitalization  of  the  pulp  only,  is  peridental 
inflammation.  Where  several  applications  of  the  arsenical  prep- 
aration fail  to  produce  the  desired  devitalization,  the  resistance 
thus  offered  to  the  influence  of  the  agent  may  be  owing  to  several 
causes  ;  a  granulated,  protective  covering,  which  is  formed  over 
the  surface  of  the  exposed  portion  of  the  pulp,  which  defends  it 


202  DENTAL  MEDICINE. 


from  the  action  of  the  arsenic;  or,  extraordinary  vital  power  in 
the  pulp,  which  may  be  due  to  the  peculiar  constitution  of  the  pa- 
tient, who  probably  would  not  be  as  susceptible  to  the  action  of 
arsenic  as  the  majority  of  persons  are,  even  if  it  were  adminis- 
tered by  the  mouth. 

Such  resistance  to  the  action  of  the  devitalizing  agent  may  be 
overcome  either  by  the  removal  of  the  granulated  surface  where 
it  exists,  or,  in  cases  of  non-susceptibility,  by  puncturing  the 
pulp  with  a  pointed  instrument,  charged  with  the  arsenical  prep- 
aration ;  first  taking  the  precaution  to  obtund  the  sensibility  of 
the  organ  by  the  application  of  a  benumbing  agent.  The  action 
of  arsenic  depends  upon  both  local  and  systemic  conditions. 
When  the  capillaries  of  the  pulp  are  congested  as  a  result  of  the 
inflammation,  the  absorption  of  the  agent  is  prevented  or  re- 
tarded, and  it  acts  chemically  upon  the  superficial  tissue  of  the 
exposed  portion  of  the  pulp  and  causes  pain,  rendering  it  neces- 
sary to  relieve  the  congestion  before  the  nerve  tissue  can  be 
primarily  affected.  In  case  of  a  lymphatic  temperament,  charac- 
terized by  low  vital  power  and  excess  of  fluids  in  the  tissues,  the 
arsenic  is  readily  absorbed  and  devitalization  speedily  results; 
whereas  in  cases  where  there  is  great  nerve-power  or  excessive 
nervous  irritability,  the  susceptibility  of  the  tissues  to  its  influence 
is  very  feeble,  and  the  devitalization  of  the  pulp  is  difficult  and 
sometimes  impossible,  unless  repeated  applications  are  made. 

It  is  not  considered  advisable  to  apply  arsenious  acid  to  a 
dental  pulp  in  an  acute  stage  of  inflammation,  and  the  method 
generally  pursued  in  such  cases  is  to  remove  the  loose  matter  in 
the  cavity,  first  applying  the  rubber  dam,  and  relieve  the  conges- 
tion by  slightly  puncturing  the  pulp  so  as  to  cause  a  slight  hem- 
orrhage. Then  apply  an  anodyne,  such  as  oil  of  cassia,  oil  of 
cloves,  eugenol,  terpinol,  or  other  agent  of  like  properties.  This 
should  be  carefully  sealed  in  the  cavity,  without  pressure  being 
made  upon  the  pulp,  for  from  one  to  three  days,  according  to  the 
degree  of  inflammation  existing  in  the  parts.  At  the  expiration 
of  such  time,  the  dressing  is  removed,  and  if  the  inflammation 
has  subsided,  as  is  shown  by  the  symptoms  presented  during  the 
period   the  dressing  has  remained  in  the  tooth,  an  application  of 


ARSENIOUS   ACID.  203 


arsenious  acid  may  be  made.  Upon  the  removal  of  the  arsenic, 
an  application  of  tannin  and  glycerin  should  be  made  in  order  to 
harden  the  devitalized  pulp  and  render  its  removal  easy  in  the 
form  of  an  entire  mass  ;  then  apply  some  efficient  antiseptic 
dressing  to  pulp-canal,  first  washing  out  with  peroxide  of  hydro- 
gen. The  use  of  dialyzed  iron  is  also  recommended,  after  the 
removal  of  the  arsenic,  as  it  is  not  always  certain  that  the 
latter  agent  has  been  carefully  applied.  The  dialyzed  iron  is 
introduced  into  the  cavity  on  a  piece  of  wood.  The  cavity 
should  be  kept  free  of  moisture  from  the  time  of  the  application 
of  the  arsenic  up  to  the  time  of  the  application  of  the  dialyzed 
iron. 

When  arsenious  acid  is  applied  to  the  surface  of  an  exposed 
pulp,  its  first  effect  is  stimulating,  followed  by  paralysis  of  the 
sensory  nerves,  inflammation  being  excited  the  degree  of  which 
depends  upon  the  quantity  of  arsenious  acid  employed.  After 
the  stimulating  effect  passes  off  the  arsenic  is  gradually  absorbed 
and  the  pulp  slowly  dies.  Too  large  a  quantity  of  the  arsenic 
will  cause  violent  inflammatory  action,  increase  the  congestion 
and  prevent  the  pulp  from  absorbing  the  agent ;  and  experience 
has  shown  that  recently  exposed  pulps  are  more  readily  devital- 
ized by  arsenious  acid  than  those  which  have  been  exposed  for  a 
considerable  time.  It  is  therefore  advisable  to  employ  minute 
quantities  of  arsenic  as  a  devitalizing  agent,  and  to  avoid  pres- 
sure on  the  pulp  when  applying  it,  so  that  the  pain  occasioned 
by  its  action  may  be  limited  to  the  space  of  one  hour  on  an 
average.  The  danger  of  an  excess  of  arsenic  passing  through 
the  apical  foramen  of  the  root  to  the  peridental  membrane  must 
always  be  guarded  against  by  carefully  regulating  the  quantity  of 
the  agent ;  on  the  other  hand  all  extraneous  matters  that  will 
interfere  with  the  action  and  application  of  the  arsenic  to  the 
exposed  surface  of  the  pulp  must  be  removed,  or  irritation  and 
pain  and  not  devitalization  will  result.  For  the  application  of 
arsenious  acid  to  the  surface  of  a  fractured  tooth,  where  it  is  dif- 
ficult to  retain  it,  the  filling  may  be  ligatured  in  place,  after  being 
covered  with  a  thin  layer  of  gutta  percha.  Dr.  E.  C.  Kirk  uses 
for  such  a  purpose  surgeon's  rubber  plaster,  carrying  it  around 


204  DENTAL  MEDICINE. 


the  tooth.  Elastic  caps  are  now  made  to  secure  devitalizing 
mixtures  in  isolated  and  fractured  teeth. 

Arsenious  acid  is  also  employed  in  dental  practice  to  obtund 
the  undue  sensitiveness  of  dentine,  but  less  frequently  now  than 
in  past  years,  as  its  action  is  due  more  to  devitalizing  energy 
than  to  a  chemical  action,  such  as  a  true  escharotic  produces, 
as  it  is  capable  of  being  absorbed  through  a  considerable  thick- 
ness of  dentine,  the  result  of  which  would  be  the  death  of  the 
pulp.  Arsenious  acid,  if  it  is  employed  for  obtunding  the  sensi- 
bility of  the  dentine,  should  be  suffered  to  remain  in  the  tooth 
but  a  very  short  time — from  one  to  three  hours — and  every 
particle  of  it  carefully  removed.  As  there  are  many  agents 
which  prove  effective  for  such  a  purpose,  it  is  much  better  to  re- 
frain from  the  use  of  arsenious  acid  as  an  obtunder  of  hyper- 
sensitive dentine. 

When  arsenious  acid  comes  in  contact  with  the  soft  tissues 
of  the  mouth,  the  result  of  careless  application,  its  irritating 
effects  become  apparent  in  from  twelve  to  twenty-four  hours, 
beginning  with  a  slight  soreness  and  some  congestion.  Small 
ulcers  then  appear  which  increase  in  depth,  but  are  not  attended 
with  much  pain,  unless  the  agent  penetrates  to  the  periosteum. 
In  such  case  the  parts  involved  eventually  become  quite  dark 
in  color,  and  sloughing  occurs  to  some  extent,  and  in  severe 
cases  necrosis  of  bone  may  result,  a  condition  which  is  known  as 
arsenical  necrosis.  Dr.  Faught  suggests  the  following  treatment : 
"  Wherever  practicable,  the  soft  tissues  should  be  curetted. 
Scarify  freely,  and  then  touch  the  wound  with  muriated  tincture 
of  iron ;  .then  cauterize  it  with  carbolic  acid  or  iodine,  and,  if 
need  be,  stimulate  further  in  a  few  days  with  another  application 
of  the  same."  Dr.  J.  A.  Johnson  recommends  in  the  treatment 
of  arsenical  stomatitis,  the  use  of  peroxide  of  hydrogen,  and  as  a 
mouth-wash  every  hour,  sulphate  of  zinc  gr.  ijss,  water  Sj,  or  a 
solution  of  glycerite  of  tannin,  and,  internally,  iodide  of  potas- 
sium, five  grains,  three  times  a  day. 


ARSENIOUS   ACID. 


205 


DENTAL    FORMULAE. 


For  Devitalizing  Pulps  of  Teeth. 
Dr.  Flagg. 
R.     Acidi  arseniosi    .    .    .  gr.j 
Morphinse  acetatis  .    .  gr.ij 
Acidi  carbolici    .    .    .  gtt.iij.    M. 
Fiat  massa. 
SiGNA. — The    proper    quantity    to    re- 
main 12  to  24  hours. 

Dr.  Pierce. 
R.     Acidi  arseniosi   .    .    .   gr.x 
Morphinas  sulphatis   .    gr.xx 

Creasoti q.s. 

To  make  a  thick  paste. 
SiGNA. — To  remain  24  hours  for  adults; 
10  hours  for  children. 

Dr.  Garrettson. 
R.     Acidi  arseniosi    .    .    . 

Morphinoe  acetatis  .    .  aa  gr.x 

Creasoti q.s. 

To  make  a  thick  paste. 
SiGNA. — To  remain  24  hours  for  adults 
10  hours  for  children. 
If  a  very  irritable  condition  is  pres- 
ent, sulphate  of  atrophia  may  be  substi- 
tuted for  morphia. 

Dr.  Hollander. 
R.     Acidi  arseniosi    .    .    .  gr.xij 
Morphinte  acetatis  .    .  gr.ij 
Olei  caryophylli  .    .    .  gtt.iv 

Creasoti q.s. 

Ut  fiat  pasta. 
R ,     Acidi  arseniosi    .    .    .  gr.v 
Acidi  tannici    ....  gr.x 
Tincturae  aconili  .    .    .  q.s. 
To  make  a  thick  paste. 
Sigma. — To  remain  24  liours. 

Dr.  J.  D.  White. 
R.     Acidi  arseniosi    .    .    .  gr.ij 
Morphinoe  suljihatis   .  gr.j 

Creasoti q.s. 

Fiat  massa. 
SiGNA. — To  remain  from  1 2  to  24  hours. 


R .     Acidi  arseniosi    .    .    .  gr.xx 
Morphinee  acetatis  .    .  gr.x 

Creasoti q.s. 

To  make  a  thick  paste. 
SiGNA. — To  remain  12  to  24  hours  for 
adults;  8  to  10  hours  for  children. 

R .     Acidi  arseniosi    .    .    .  gr.x 
Morphinae  acetatis  .    .  gr.xl 
Creasoti,  vel  acidi  car- 
bolici     q.s. 

To  make  a  thick  paste. 
SiGNA. — To  remain  12  to  24  hours. 

Dr.  E.  C.  Kirk. 
R .     Acidi  arseniosi    .    .    . 

Cocaini  hydrochloratis.  aa  gr.xx 
Menthol  cryst  ....  gr.v 

Glycerini enough    to 

make  a  stiff  paste,  M. 

SiGNA. — Use  the  desired  quantity,  and 
secure  it  with  a  lead  cap  covered 
with  gutta  percha. 

R ,  Acidi  arseniosi  .  .  .  i  part 
Cocaine  hydrochloras.  4  parts 
Lanolin 5  parts.  M. 

SiGNA. — To  remain  24  hours. 

For  Painless  Devitalization. 

R.     Acidi  arseniosi    .    .    .  %r.-^^ 

Olei  caryophilli  .    .    .  enough   to 
make  a  paste.  M. 

Or  a  pledget  of  cotton  may  be  satur- 
ated with  the  oil  of  cloves  and  the 
arsenious  acid  taken  up  on  this  and 
applied  to  the  pulp. 

Devitalizing  Fibre. 
R,     Absorbent  cotton    .    .      (crosscut 
fine.) 

Acidi  arseniosi    .    .    .  gr.v 
Acidi  tannici    ....  gr.ij 
Morphine  acetas    .    .  gr.x 
Acidi  carbolici  (ol.)  .  q.s.    for    a 
thin  paste. 


206 


DENTAL  MEDICINE. 


Reduce  the  cotton  by  cutting  and  cross- 
cutting  to  a  soft  fine  fuzz,  then  in- 
corporate it  with  the  above  mixture ; 
dry  and  separate  into  small  pieces 
for  convenient  application. 

Or  arsenic,  morphine  and  cinnamon 
applied  to  cotton  in  same  manner  as 
above. 

Devitalizing  Pulps  of  Teeth. 

Dr.  a.  W.  Harlan. 
First    apply  to    point    of    exposure 
vinum  opii  or  any  anodyne  (not  car- 
bolic acid)  for  a  minute  or  two,  then 
use  the  following : 

R.     Acidi  arseniosi    .    .    .  3J 
Hydrochlorate    of    co- 
caine     gij 

Lanolin ad.q.s. 

To  make  a  stiff  paste, 
SiGNA. — Apply  a  small  quantity  to  the 
exposure  on  a  little  square  of  gummed 
paper  about  ^-^  of  an  inch  in  size; 
this  should  be  covered  with  a  pellet 
of  cotton  saturated  with  liquid  vase- 
line and  the  cavity  filled  with  soft 


gutta  percha,  or  paste  of  oxyphos- 
phate  of  zinc.  This  application 
should  remain  48  hours  in  the  case 
of  an  adult ;  24  hours  in  case  of  a 
patient  under  21  and  more  than  12 
years  of  age;  and  8  to  12  hours  in 
case  of  a  patient  under  12  years  of 
age. 

For  Destroying  and  Removing  Pulps. 

Dr.  a.  W.  Harlan. 
R.     Acidi  arseniosi    .    .    .  gr.xc 
Cocaini  hydrochlor.    .  gr.x 

lodoformi gr.v  to  vij 

Either  oil  of  cloves,  or 
oil  of  cassia    .    .    .  q.s. 
To  form  a  stiff  paste. 
Apply  ^ij  grain  to  the  pulp  and  allow  it 
to  remain  48  hours.    Seal  cavity  with 
gutta  percha,  when  the  dressing  is 
removed  keep  cavity  dry,  and  wash 
it  with  dialyzed  iron,  and  apply  alco- 
holic solution  of  tannin.    Seal  cavity 
for  8  days,  when   the  pulp  may  be 
removed  painlessly.     The  root  may 
be  filled  at  once. 


Tests  for  Jrsenic. — Arsenic,  in  the  solid  state,  may  be  detected 
by  its  volatility ;  heated  over  a  spirit-lamp,  it  passes  off  in  the 
form  of  a  white  vapor,  devoid  of  smell,  and  is  deposited  on  a 
cool  surface  as  an  amorphous  powder,  or  in  octahedral  crystals. 
When  arsenic  is  thrown  on  burning  charcoal,  it  is  deoxidized, 
and  gives  out  the  garlic  ordor  of  metallic  arsenic.  When  heated 
in  a  glass  tube  with  charcoal  or  black  flux,  it  sublimes,  and  con- 
denses in  the  form  of  a  brilliant  steel-gray  ring  or  mirror. 

The  following  reagents  will  detect  it  when  it  is  in  aqueous 
solution  :  Sulphuretted  hydrogen,  or  sulphide  of  ammonium,  pro- 
duces a  lemon  or  yellow  sulphide  of  arsenic  ;  the  addition  first  of 
ammonia,  and  then  of  nitrate  of  silver,  produces  a  light-yellow 
arsenite  of  silver ;  the  addition  of  potassa,  and  then  of  sulphate  of 
copper,  produces   a  light-green   arsenite  of  copper.     The   most 


BENZOIC  ACID.  207 


delicate  test,  however,  is  that  of  nascent  hydrogen,  known  as 
Marsh's  Test,  which  consists  in  subjecting  the  arsenic  to  the 
action  of  nascent  hydrogen  (evolved  by  the  action  of  diluted  sul- 
phuric acid  on  pure  zinc) ;  it  is  deoxidized,  and  unites  with  the 
hydrogen  to  form  arseniuretted  hydrogen  gas,  which  has  the 
odor  of  garlic,  and  burns  with  a  bluish-white  flame,  depositing  a 
black  spot  of  metallic  arsenic  on  the  surface  of  a  cold  plate  held 
directly  in  the  jet. 

Reinsch's  Test  consists  in  boiling  the  suspected  material  with 
hydrochloric  acid  and  clean  copper  foil,  when,  if  any  arsenic  is 
present,  the  copper  foil  becomes  coated  with  gray  metallic 
arsenic. 

Cobalt. — Cohaltum  [Formula^  Co) — is  a  metal  chiefly  found  in 
combination  with  arsenic,  either  in  the  form  of  the  arsenide  {tin- 
white  cobalt)^  or  as  gray  cobalt  ore,  with  sulphur  and  arsenic. 
The  late  Dr.  Robert  Arthur,  at  one  time,  preferred  cobalt  as  a 
devitalizing  agent  to  arsenious  acid,  being  of  the  opinion  that  less 
irritation  followed  its  action,  and  consequently  greater  immunity 
from  peridental  inflammation ;  afterwards,  however,  he  found  it 
less  reliable  than  arsenious  acid.  At  the  present  time  cobalt  is 
not  considered  to  be  any  safer  than  arsenic;  it  is  also  less  prompt 
in  its  action  as  a  devitalizing  agent. 

ACIDUM    BENZOICUM— BENZOIC   ACID. 

Formula.— Q.Y{f^.r^Q^.—QO,OY{. 

Derivation. — Benzoic  acid  is  obtained  from  benzoin  (a  bal- 
samic resin,  which  exudes  from  the  incised  stem  of  a  tree  of 
Sumatra,  Java,  Borneo  and  Siam),  either  by  sublimation  or  by  the 
action  of  alkalies  ;  it  is  also  made  from  hippuric  acid.  It  is  in 
the  form  of  white,  feathery  crystals,  of  a  silky  lustre,  a  peculiar, 
agreeable  odor,  and  warm,  acidulous  taste.  While  it  is  sparingly 
soluble  in  cold  water,  it  is  more  soluble  in  warm  or  boiling  water, 
and  very  soluble  in  alcohol,  solutions  of  potassa,  soda,  ammonia, 
lime  and  concentrated  sulphuric  and  nitric  acids.  The  fixed  oils 
also  dissolve  it.  fVom  solution  it  crystallizes  in  transparent 
prisms.     It  is  also  inflammable. 


DENTAL  MEDICINE. 


Medical  Properties  and  Action. — Benzoic  acid  is  stimulant,  par- 
ticularly of  mucous  surfaces,  and  its  vapor  causes  great  irritation 
of  the  air  passages.  It  is  also  antiseptic  and  expectorant,  and 
some  claim  that  it  is  a  more  powerful  antiseptic  than  carbolic  acid. 
Like  salicylic  and  boracic  acids,  it  prevents  fermentation  and 
putrefaction  and  destroys  minute  organisms.  In  the  system  it  is 
converted  into  hippuric  acid,  by  the  assumption  of  the  elements 
of  glycocol,  and  in  this  form  is  excreted  in  the  urine ;  a  large 
part  is  excreted  by  the  kidneys,  as  benzoic  acid. 

Therapeutic  Uses. — Benzoic  acid  is  employed  in  chronic  cys- 
titis, gout,  calculous  diseases,  jaundice,  incontinence  of  urine  in 
children,  etc. 

Dose. — Gr.  x. 

Dental  Uses. — Benzoic  acid  is  used  as  a  mouth-wash  for  dis- 
eases of  the  oral  mucous  membrane  in  solution — 5ij  or  more  to 
Sij  of  water ;  also  as  an  injection  in  fractures  of  the  jaws  where 
the  mouth  cannot  be  opened  to  any  extent.  It  may  also  be  em- 
ployed as  an  antiseptic  in  suppurating  and  gangrenous  conditions 
of  the  pulps  of  teeth  and  mucous  membrane;  also  as  a  local 
hemostatic  in  combination  with  powdered  alum.  It  forms  one 
of  the  ingredients  of  Dr.  Chapin  A.  Harris'  Gum  Wash. 

The  tinctures  of  benzoin  are  employed  in  the  treatment  of  un- 
healthy and  sloughing  wounds,  flabby  granulations,  foul  ulcers,  as 
they  destroy  the  fetor  and  stimulate  to  a  more  healthy  growth. 
The  compound  tincture  combined  with  the  tinctures  of  iodine, 
aconite,  and  cannabis  indica,  forms  an  excellent  counter-irritant 
for  incipient  periodontitis,  pulpitis,  alveolar  pyorrhoea,  etc.,  etc. 
In  the  antiseptic  employment  of  benzoic  acid,  it  may  be  used  as 
a  substitute  for  boracic  and  salicylic  acids.  The  addition  of 
borax  will  increase  its  solubility  in  water. 

Benzoate  of  Ammonium — Jmmonii  Benzoas — will  dissolve 
phosphatic  calculi,  if  its  use  is  long  continued. 

Benzoated  lard,  when  employed  in  the  preparation  of  oint- 
ments, prevents  chemical  change,  such  as  rancidity  or  acridity. 
It  is  prepared  by  digesting,  at  a  moderate  heat,  o'j  of  powdered 
benzoin  with  a  pound  of  lard. 


BENZOIC  ACID. 


209 


Antiseptic  Mouth  Wash. 
Dr.  W.  D.  Miller. 

K .         Acidi  benzoic! 3- 

Tinct.  eucalypti 'S- 

Alcoholis loo. 

01.  Menth.pip 0.75 

For  an  Antiseptic  and  Disinfectant  Mouth  Wash. 
Dr.  L.  p.  Bethel. 

R.         Benzoic  acid 
Orris  root 

Cinnamon,  pv.,  aii X°^ 

Soap  bark 2-oz 

Tannic  acid Jdr 

Borax gr.20 

01.  wintergreen 3°1fU, 

01.  peppermint idr 

Cochineal X^"" 

Sugar 4-oz 

Alcohol 12-0Z 

Water 20-oz       M. 

Macerate  6  days  and  filter. 

SiGNA. — For  rinsing  purposes  6  or  8  drops  in  half  a  glass  of  water.     In 
stronger  solution  for  inflammation  and  pain  after  extraction. 


LiSTERiNE,  the  formula  of  which  is  thyme,  eucalyptus,  baptisia, 
gaultheria,  and  mentha  arvensis,  in  combination,  each  fluid 
drachm  also  containing  two  grains  of  benzo-boracic  acid,  is 
largely  employed  as  an  antiseptic,  deodorizer,  and  disinfectant,  in 
surgical  practice,  in  the  form  of  a  lotion,  a  gargle,  a  dressing,  or 
an  injection.  In  dental  practice,  listerine  is  reliable  in  inflamma- 
tions and  ulcerations  of  mucous  membrane,  and  wounds  of  the 
mouth,  in  the  form  of  a  lotion  or  dressing  ;  for  alveolar  abscesses, 
necrosis  and  caries  of  maxillary  bones,  in  the  form  of  injections 
and  lotions  ;  after  the  extraction  of  teeth,  as  a  mouth  wash  ;  and 
for  offensive  breath,  as  a  gargle.  It  may  be  employed  in  its  full 
strength,  or  in  various  degrees  of  dilution  with  water. 

For  such   diseases  as  diphtheria,  catarrh,  dysentery,  scarlatina, 

erysipelas,  smallpox,  diff"erent   forms  of  fevers,  etc.,  the  dose  is 

one  teaspoonful  three  or  more  times  a  day  (as  indicated). 
14 


210  DENTAL  MEDICINE. 


For  Stomatitis  of  Dentition , 

Bt.     Listerine gj  R.     Listerine ^j 

Syr.  simplicis  .    .    .    .  jvij      M.  Glycerine gss 

Water  ....  q.s.  ad.  ^  ij        M. 
SiGNA. — A    teaspoonful  every   2  to  4 
hours  after  nursing  or  feeding. 

or — 

For  Sore  Mouth  of  Nursing  Women. 
U .         Listerine 

Glycerine aa  3  vj 

Rose  water S'J^^  ^^■ 

SiGNA. — Use  as  a  mouth  wash. 

Local  Anesthetic. 
Dr.  L.  p.  Bethel. 

IJ.         Listerine ^ij 

Carbolic  acid  (crystals) grs.x 

Gum  camphor grs.viij 

Iodoform jss 

Pond's  ext.  hammamelis ^  ij  M. 

SiGNA. — Used  hypodermically. 

ACIDUM  BORICUM— BORIC  ACID— BORACIC  ACID. 

Formula. — H3BO3. 

Derivation. — Boric  acid,  formerly  called  Boracic  Acid,  is  ob- 
tained artificially  by  decomposing  a  hot  saturated  solution  of  borax 
with  sulphuric  acid,  which  unites  with  the  soda  to  form  sulphate 
of  soda,  and  liberates  the  acid.  It  is  in  the  form  of  white,  shining 
crystals,  of  a  scaly  nature.  It  is  soluble  in  26  parts  of  cold  water, 
in  three  parts  of  warm  water,  and  feebly  soluble  in  alcohol. 

Medical  Properties  and  Action. — Boric  acid  is  antiseptic  and 
deodorant.  It  destroys  minute  organisms,  and  arrests  fermenta- 
tion and  putrefactive  decomposition,  and  is  said  to  be  a  more 
effective  antiseptic  than  carbolic  acid,  and  less  irritating  than 
salicylic  acid. 

Therapeutic  Uses. — It  is  locally  employed  as  a  dressing  for 
wounds,  ulcers,  burns,  scalds,  skin-grafting,  etc.,  as  it  is  non-irri- 
tating, and  lessens  suppuration,  and  prevents  decomposition. 
Boric  acid  is  employed  in  all  the  forms  and  combinations  in 
which  carbolic  and  salicylic  acids  are  used  by  the  antiseptic 
method,  in  the  form  of  a  saturated  solution. 


BORACIC   ACID.  211 


Boric  Lint  is  made  by  steeping  lint  in  a  saturated  solution  of 
boric  acid  at  the  boiling  point. 

Dose. — Of  boric  acid,  gr.  viij  to  xvj.  It  does  not  cause  any 
disturbance  of  the  stomach,  and  is  eliminated  in  the  urine. 

Boro-glyceride  is  composed  of  boric  acid  62  parts,  and  glycerine 
92  parts,  each  gently  heated  over  a  water  bath  and  the  boric  acid 
gradually  added  to  the  glycerine,  and  the  heat  continued  until  54 
parts,  or  three  molecules  of  water  are  driven  off.  It  is  amber- 
colored  and  very  friable,  and  proves  to  be  a  valuable  antiseptic. 

Boro-glycerine  has  an  acid,  pungent  taste,  and  an  astringent 
effect  on  mucous  membranes,  and  is  free  from  some  of  the  ob- 
jections to  the  use  of  the  boric  acid  powders.  (See  Glycerine 
for  Glyceroborates  of  Sodium  and  Calcium.) 

Boric  Ointment  is  composed  of  boric  acid,  I  part ;  paraffin,  2 
parts  ;  almond  oil,  2  parts.  When  used  it  should  be  mixed  with 
a  little  glycerine. 

Mel  Sodii  Boratis — Honey  of  Borax — is  composed  of  borax,  60 
grains ;  honey,  i  troy  ounce. 

Borolyptol. — Antiseptic  and  germicidal.  Composed  of  aceto- 
boro-glyceride,  formaldehyde,  pinus  pumilis,  eucalyptus,  myrrh, 
storax  and  benzoin.  Employed  externally  and  internally.  Dose 
for  internal  use,  oij- 

Dental  Uses. — Boric  acid  may  be  employed  as  an  antiseptic  in 
all  the  forms  and  combinations  in  which  carbolic  and  salicylic 
acids  are  used,  and  when  it  is  combined  with  sulphite  of  soda  the 
compound  forms  a  valuable  preparation  for  bleaching  discolored 
teeth.     (See  Sulphite  of  Soda.) 

Boric  acid  in  a  ten  per  cent,  solution,  may  be  used  with  benefit 
in  the  form  of  an  injection  into  suppurating  cavities,  necrosis  and 
caries  of  bone,  etc.  As  a  mouth-wash  and  gargle  it  is  employed 
in  a  solution  composed  of  twenty  grains  to  the  ounce  of  water. 
Combined  with  glycerine  in  the  form  of  boro-glyceride,  a  valuable 
application  is  secured  for  antiseptic  dressings  and  injections. 
One  part  of  boric  acid  in  130  of  water  is  used  as  a  germicide. 

For  the  sterilization  of  mucous  surfaces  a  saturated  aqueous 
solution  is  commonly  employed.  Boric  acid  is  also  an  ingredient 
of  some  dentifrices. 


212 


DENTAL  MEDICINE. 


For  Alveolar  Pyorrhoea. 

R.     Creta  preparata  .    .  ^j 

Acidi  Borici     .    •    •  3J  M. 

SiGNA. — Apply  this  powder  to  gums 
about  necks  of  teeth,  after  all  de- 
posits have  been  thoroughly  removed, 
and  aromatic  sulphuric  acid  injected. 

For  Chapped  Lips  and  Abrasions. 

R .     Acidi  borici  ....     2  parts 

Vaselin 30  parts 

Glycerini      ....    3  parts 

Attar  of  roses,  for  perfume,  a  few  drops, 
if  used  as  a  lip  salve. 

Antiseptic  Mouth  IVash. 

R.     Boric  acid ^ss 

Carbolic  acid gr.xv 

Thymol gr.iv 

Water Oj       M. 


Mouth  IVash. 


R,  Boro-glycerine  .  .  .  .  ^j 
Carbolic  acid  .  .  .  .  ^} 
Water ^xyj 

For  Capping  Exposed  Pulps. 

R.     Acidi  borici 

White  wax  .    .    .  aa  i  part 

Oil  sweet  almonds 
Paraffin aa  2  parts     M. 


For    Aphthous  Ulcerations  of   Mouth, 

Fissured  Tongue,  Abrasions  by 

Artificial  Dentures,  etc. 

Dr.  C.  N.  Peirce. 

R.     Acidi  borici     ....  grs.lxiv 

Olei  gaultheriae  .    .    .  f^ss 

Glycerini ^^S^v 

Alcoholis f^j 

Aquse  enough  to  make  4  ounces.       M. 

Temporary  Capping  for  Exposed 

Pulps. 

Dr.  H.  Milling. 

R.     Boric  acid 

White  wax aa    I   part 

Oil  of  sweet  almonds 

Paraffin aa  2  parts 

Antiseptic  Solution. 

Thiersh. 

R.     Acidi  borici g''s.76 

Acidi  salicyli  ....  grs.xvj 
Aquse  ferventis  .    .    .  Oj.         M. 
Antiseptic -Mouth  Wash. 

R .     Boric  acid ^  vij 

Phenic  acid     ....  grs.xv 

Thymol grs.viij 

Essence  peppermint  .  gtt.xx 
Tinct.  anise  ....  ^ijss 
Water Oij  M. 

For  Eczema,  etc. 

R.     Acidi  boraci  ....  grs.viij 

Aquae   destillatse  .    .  ^j  M. 

SiG. — Use  as  a  lotion. 


ACIDUM  CARBOLICUM— CARBOLIC  ACID. 
PHENIC  ACID;    PHENYLIC  ALCOHOL  ;    PHENOL. 
Formula.— Q^Yi^OW. 

Derivation. — Carbolic  Acid  is  obtained  from  coal  tar  by  frac- 
tional distillation  and  subsequent  purification,  being  extracted 
from  that  part  of  the  heavy  coal  tar  oils  which  distill  over  be- 
tween 150°  and  200°  Centigrade.     Specific  gravity  1.065. 


CARBOLIC   ACID.  213 


When  pure,  it  is  in  the  form  of  colorless  acicular,  interlacing 
crystals,  which  at  95°  F.  become  an  oily  liquid,  possessing  a 
strong  odor  and  taste,  closely  resembling  creasote,  having  similar 
characters  and  properties,  although  it  is  a  different  substance. 
Much  of  what  is  called  creasote  is  nothing  but  impure  carbolic 
acid  i^Jcidum  Carbolicum  Impurum)^  combined  with  two  other  sub- 
stances, similar  in  constitution,  and  known  as  creasole  and  phosole. 

Chemically  considered,  carbolic  acid  is  an  alcohol  rather  than 
an  acid,  and  its  crystals  readily  absorb  moisture  on  exposure  to 
the  air,  and  are  thus  liquefied. 

It  crystallizes  at  70°  F.,  and  becomes  liquid  at  from  90°  to 
95°  F.,  and  fuses  at  93°  to  106°.  It  is  freely  soluble  in  alcohol, 
ether,  chloroform,  glycerine  and  the  essential  oils.  When  car- 
bolic acid  is  liquefied  and  discolored  by  exposure,  it  is  difficult  to 
detect  it  from  creasote,  as  it  possesses  the  same  odor,  taste,  caus- 
tic properties,  and  a  like  affinity  for  albumen.  Carbolic  acid  is 
soluble  in  from  twenty  to  twenty-three  parts  of  water,  the  purest 
being  the  most  soluble.  A  small  quantity  of  water  will  convert 
it  into  the  liquid  state,  but  will  not  dissolve  it.  Water  dissolves 
six  per  cent,  of  carbolic  acid  and  five  parts  dissolve  in  one  part 
of  alcohol;  four  in  one  part  of  ether;  three  in  one  part  of 
chloroform ;  seven  in  two  parts  of  glycerine,  and  four  in  seven 
parts  of  olive  oil.  It  is  also  soluble  in  carbon  disulphide,  benzol 
and  fixed  and  volatile  oils.  The  best  quality  of  carbolic  acid 
contains  two  per  cent,  of  water  and  should  be  hard  and  dry,  with 
no  odor  of  creasote  nor  of  volatile  sulphur  compounds.  Crys- 
tallized carbolic  acid  may  be  dissolved  by  a  small  quantity  of 
cologne  water;  and  to  prevent  recrystallization  and  prepare  it  for 
use  (in  the  form  of  injections,  for  example),  the  bottle  containing 
it  should  be  warmed  by  immersion  in  hot  water,  until  it  becomes 
fluid,  and  about  five  per  cent,  of  rectified  alcohol,  or  a  few  drops 
of  glycerine,  be  added. 

The  red  color  which  it  assumes  on  exposure  is  thought  to  be 
caused  by  the  ammonia  in  the  air,  and  also  by  the  presence  of 
copper  in  the  acid,  which  is  affected  by  the  ammonia  of  the  at- 
mosphere. 

Medicinal  Proper-ties  and  Jetton.— QdiVhoWc  acid  resembles  crea- 


214  DENTAL  MEDICINE. 


sote  so  closely  in  many  of  its  characters  and  medicinal  properties, 
that  the  therapeutic  applications  are  the  same  in  the  case  of  both 
of  these  substances.  Many,  however,  consider  carbolic  acid  to 
be  more  efficacious  in  obstinate  discharges  than  creasote ;  and 
also  less  irritating  in  its  crystalline  form  when  applied  to  very 
sensitive  organs,  such  as  the  pulp  of  a  tooth. 

In  its  pure  state  it  is  escharotic ;  when  diluted,  it  is  rube- 
facient, anaesthetic  and  antiseptic.  Internally  administered,  it  is 
sedative  and  carminative,  possessing  the  power  of  allaving  vom- 
iting and  gastric  irritability. 

Its  powers  as  an  antiseptic  and  germicide  are  not  now  con- 
sidered to  be  equal  to  those  of  some  other  substances,  such  as 
bichloride  of  mercury,  iodine,  aristol,  etc.,  although  it  is  yet 
regarded  as  a  useful  and  important  agent.  It  is  irritant  to  the 
skin  and  other  tissues,  and  capable  of  being  absorbed  to  a  dan- 
gerous amount.  Eisentein  regards  carbolic  acid  as  an  antipyretic 
as  inferior  to  salicylic  acid,  and  others  regard  boric  acid  as  pos- 
sessing equal  antiseptic  properties.  As  a  local  anaesthetic,  car- 
bolic acid  exerts  a  very  soothing  influence  upon  painful  tissues  ; 
hence  it  is  beneficial  in  odontalgia,  and  for  pulp  dressing.  On 
account  of  its  solubility,  a  variety  of  solutions  of  special  value 
can  be  formed  with  it,  which  are  especially  serviceable  as  anti- 
septic applications. 

The  application  of  large  quantities  of  carbolic  acid  to  an  ex- 
tensive surface  is,  however,  dangerous,  as  cases  of  fatal  poison- 
ing have  resulted  by  the  absorption  of  this  acid;  hence,  care  is 
necessary  in  its  use  as  an  external  application. 

Its  nauseous  odor  and  taste  and  its  caustic  action  render  it 
objectionable,  unless  greatly  diluted,  for  internal  administration. 
To  obviate  such  objections,  it  is  recommended  to  use  it  in  the 
form  of  sulpho-carbolates. 

When  applied  to  the  skin  or  to  mucous  membrane,  it  pro- 
duces a  burning  sensation,  of  short  duration,  and  the  eschar  is  at 
first  whitish,  afterward  becoming  brown  or  black,  and  surrounded 
by  a  zone  of  inflammatory  redness ;  and,  notwithstanding  its 
power  to  coagulate  albumen,  is  rapidly  difi^used  into  the  blood. 
Carbolic  acid  exists  in  the^  blood  as  a  carbolate ;  and  the  blood 


CARBOLIC   ACID.  215 


itself  does  not  appear  to  undergo  any  change  in  its  corpuscular 
elements.  It  is  in  part  consumed  in  the  body,  and  the  products 
of  its  combustion  are  excreted  in  the  urine.  Solutions  of  car- 
bolic acid  of  adequate  strength  will  check  suppuration,  and  cor- 
rect the  fetor  of  ulcers,  and  has  a  beneficial  effect  on  bone  as 
well  as  on  the  soft  tissues  in  necrosis,  etc. 

Therapeutic  Uses. — Internally,  it  is  employed  for  nausea  and 
vomiting  due  to  an  irritable  state  of  the  stomach,  in  scarlatina, 
measles  and  smallpox,  pyrosis,  etc.;  as  a  gargle  in  diphtheria; 
as  an  inhalation  in  chronic  nasal  catarrh,  hay  asthma,  whooping- 
cough,  phthisis,  etc. ;  as  an  injection  in  chronic  cystitis,  primary 
syphilis,  erysipelas,  pleuro-pneumonia  and  uterine  diseases ;  as  a 
lotion  in  gangrenous  and  other  ill-conditioned  ulcers,  carbuncle, 
poisoned  wounds,  burns,  skin  diseases,  scrofulous  ophthalmia 
and  itching  of  the  skin. 

Dose. — Of  crystallized  carbolic  acid,  gr.  y^  to  gr.  j,  largely 
diluted.  A  better  form,  however,  is  one  drop  of  the  crystallized 
acid,  liquefied  by  heat,  in  one  ounce  of  mucilage,  three  times  a 
day.  The  dose  of  glycerite  of  carbolic  acid  {Glyceritum  Acini 
Carbolici).,  made  by  rubbing  together  .5ij  of  carbolic  acid  with 
Oss  of  glycerine,  is  TTLiv. 

The  dose  of  carbolic  acid  water  {^Aqua  Acidi  Carbolici)^  f5x ; 
of  the  glycerite,  dissolved  in  distilled  water,  enough  to  make  the 
mixture  measure  a  pint,  the  dose  is  foss  to  f 5j. 

Impure  carbolic  acid  is  employed  for  disinfectant  purposes. 

Ointment  of  carbolic  acid  {Unguentum  Acidi  Carbolici) — car- 
bolic acid,  5j ;  lard,  ,5J. 

Sulphophenol.—Sulpho-carbolic  acid,  C«H,  (OH)  (SOaOH)^^ 
CgHgSO^,  is  produced  by  the  action  of  sulphuric  acid  on  phenol, 
and  is  considered  to  be  a  very  efficient  antiseptic  and  disinfect- 
ant. The  addition  of  acids,  particularly  sulphuric,  to  crude 
carbolic  acid  of  different  strengths,  increases  its  antiseptic  and 
disinfectant  properties,  and  considerably  increases  its  solubility. 
Twenty-five  per  cent,  of  crude  carbolic  acid,  mixed  with  an  equal 
quantity  of  concentrated  crude  sulphuric  acid,  gives  the  best  results, 
and  renders  it  a  cheap  and  effective  disinfectant  and  sterilizer. 

Aseptol.,  crude  sulphophenol  (sulpho-carbo  orthoxyphenyl-sul- 


216  DENTAL  MEDICINE. 


phurous  acid),  is  a  syrupy  rose-colored  volatile  liquid  with  a 
strong  odor,  and  a  non-irritant  action.  It  readily  dissolves  in 
every  proportion  of  water,  alcohol  and  glycerine.  Although  it  is 
more  acid  than  carbolic  acid,  yet  it  is  less  caustic,  and  directly 
combines  with  bases.  It  is  non-toxic,  anti-fermenting,  anti- 
putrid,  and  its  disinfecting  properties  are  more  energetic  than 
those  of  carbolic  and  salicylic  acids.  It  can  readily  be  combined 
with  the  essential  oils.  It  is  recommended  as  a  substitute  for 
carbolic  acid. 

Sulpho-carbolate  of  zinc  (Zn(CgH5SO^)2H20)  combines  the 
virtues  of  zinc  salts  and  carbolic  acid,  and  is  used  internally,  in 
diarrhoea,  and  externally,  in  aqueous  solution  of  from  three  to  six 
grains  to  the  ounce,  as  a  dressing  for  wounds  and  ulcers,  and  an 
injection  in  gonorrhoea. 

Sulpho-carbolates  of  sodium,  potassium,  magnesium,  calcium 
and  quinia  are  employed  as  antiseptics  in  cholera  and  zymotic 
diseases  generally. 

Dental  Uses. — Carbolic  acid  being  antiseptic,  styptic,  escha- 
rotic,  stimulant  and  sedative,  or  narcotic,  is  a  valuable  agent  in 
dental  therapeutics.  It  has  been  employed  as  an  application  to 
carious  dentine,  to  obtund  sensibility  and  arrest  putrefactive 
changes  in  the  devitalized  structure,  and  to  coagulate  the  albu- 
minous elements  at  the  end  of  the  dentinal  tubuli. 

But  it  is  now  generally  conceded  that  there  are  other  agents 
which  are  more  permanent  in  their  action  as  antiseptics,  and 
hence  carbolic  acid,  it  is  claimed,  should  not  be  introduced  into 
root-canals  permanently,  as  silico-fluoride  of  sodium,  boro-glycer- 
ine,  aristol,  oil  of  cloves,  cassia,  cinnamon,  myrtol,  etc.,  are  far 
more  powerful,  with  better  stimulating,  antiseptic  and  disinfectant 
properties,  and  do  not  possess  the  coagulating  property  of 
carbolic  acid,  nor  clog  a  delicate  canal  or  destroy  the  tissues  to 
which  they  are  applied.  Carbolic  acid  relieves  odontalgia  when 
applied  to  the  surface  of  an  exposed  and  painful  pulp.  It  is  also 
invaluable  in  the  treatment  of  alveolar  abscess ;  and  in  com- 
bination with  iodine  or  other  agents  it  is  often  employed  with 
beneficial  effects  in  the  treatment  of  periodontitis.  When  em- 
ployed in  the  treatment  of  alveolar  abscess,  as  an  antiseptic,  al- 


CARBOLIC  ACID.  217 


though  the  discharge  of  pus  may  be  increased  for  a  short  time 
after  its  application  there  is  soon  manifested  a  decided  dimi- 
nution in  the  quantity  secreted.  When  applied  to  a  suppurating 
pulp  it  arrests  putrefaction,  and  induces  a  healthy  action  without 
irritation.  It  is  also  a  valuable  antiseptic  application  in  ulcer- 
ations of  the  mucous  membrane  of  the  mouth,  gangrenous  con- 
ditions and  mercurial  stomatitis  ;  for  such  purposes  it  is  com- 
bined with  glycerine  and  other  agents.  Applied  to  exposed 
pulps,  it  forms,  by  its  escharotic  action,  an  eschar,  which  some 
regard  as  conducive  to  the  recovery  of  the  organ,  while  others 
regard  the  quiescent  state  it  produces  as  an  indication  of  the  de- 
generation of  the  pulp,  and  hence  prefer  to  use  it  in  a  diluted 
form,  for  the  same  object,  objecting  to  its  employment  in  its 
pure  state,  on  account  of  its  escharotic  or  caustic  action. 

It  is  also  useful  as  a  styptic  in  case  of  superficial  hemorrhage 
from  the  gums  after  the  extraction  of  teeth,  especially  in  combi- 
nation with  other  agents.  A  preparation  known  as  phenol  sodique 
is  often  employed  for  such  a  purpose. 

Oil  of  cloves,  when  added  to  an  equal  quantity  of  carbolic 
acid,  will  disguise,  to  some  extent,  its  taste  and  odor.  It  can 
also  be  perfumed  by  adding  to  I  part  of  carbolic  acid  3  parts  of 
oil  of  lemon  and  lOO  parts  of  alcohol  (36  degrees).  Carbolic 
acid  is  also  employed  to  check  the  hemorrhage  resulting  from 
the  application  of  leeches  to  the  mucous  membrane  of  the  mouth. 
When  applied  to  an  ulcerated  surface,  it  should  be  repeated,  as 
pus  is  formed  or  fungous  growths  appear  ;  and  having  formed  an 
eschar  when  applied  to  an  exposed  pulp,  it  should  not  be  re- 
peated until  the  eschar  is  detached  from  the  surface.  It  has  also 
been  employed  in  the  form  of  hypodermic  injections,  for  the 
relief  of  neuralgia. 

Carbolic  acid  is  also  useful  as  a  local  anaesthetic.  Combined 
with  glycerine  (i  part  to  12  of  glycerine),  it  will  stimulate  the 
mucous  secretion,  and  hence  has  been  applied  to  the  palate  in 
cases  of  deficiency  of  this  secretion  to  promote  the  suction  of 
upper  dentures. 

When  properly  diluted  with  alcohol,  it  renders  soft  and 
spongy  gums  firmer  and  less  tender. 


218  DENTAL  MEDICINE. 

It  will  also  correct  fetor  of  the  breath  arising  from  carious 
teeth,  smoking,  etc.,  acting  as  a  deodorizer. 

In  all  fetid  discharges  from  the  mouth,  throat,  etc.,  carbolic 
acid,  combined  with  glycerine  or  an  aqueous  solution,  may  be 
used  with  advantage.  The  pure  acid  is  employed  for  bathing 
cavities  in  teeth,  preparatory  to  the  introduction  of  the  filling 
material,  for  its  effect  on  sensitive  or  softened  dentine  and  low 
organisms,  although  other  agents  prove  more  effective  as  ger- 
micides. Carbolic  acid,  combined  with  glycerine  and  rose 
water,  forms  an  antiseptic  mouth-wash ;  and  when  prepared 
chalk  is  added  to  the  combination,  it  forms  a  tooth-paste. 

For  use  as  a  disinfectant,  the  form  of  carbolic  acid  which 
contains  about  ninety-four  per  cent,  of  the  pure  acid  and 
known  as  "carbolic  acid  No.  4,"  is  the  best,  and  it  may  be  used 
as  an  antiseptic  in  the  following  strength  :  for  lotions  or 
sponges,  ly^  per  cent,  in  water;  for  spray  or  vapor,  5  per  cent, 
in  water;  for  a  dressing,  5  per  cent,  in  olive  oil.  Carbolate  of 
potash  (unofficial — Robinson's  remedy)  is  composed  of  equal 
parts  of  carbolic  acid  and  caustic  potassa  rubbed  together;  it  is 
employed  in  pyorrhoea  alveolaris  and  hyper-sensitive  dentine. 
Carbolic  acid  one-third  and  potassa  fusa  two-thirds  is  escharotic, 
anaesthetic,  obtundent  and  disinfectant ;  such  a  combination 
causes  a  definite  slough,  and  is  useful  in  suppurating  surfaces, 
sloughing  ulcers  and  dead  tissue. 

Synthetic  Carbolic  Acid. — Hitherto  all  carbolic  acid  used  in 
medicine  has  been  prepared  from  coal-tar.  But  such  an  acid  is 
never  quite  pure,  always  containing  impurities  derived  from  the 
coal-tar.  Synthetic  carbolic  acid  is  produced  during  the  process 
of  sulphonizing  benzol  and  subsequent  fusion  of  the  benzol- 
sulphonate  with  caustic  alkali.  The  most  characteristic,  differ- 
ence between  it  and  the  acid  prepared  from  coal-tar  is  the  odor, 
the  synthetic  acid  having  a  faint  "  pure  "  odor  not  like  that  of 
coal-tar,  and  almost  unperceivable  in  a  5  per  cent,  aqueous 
solution,  differing  in  this  respect  also  from  the  commercial 
article.  Synthetic  carbolic  acid  is  in  two  forms — in  a  coherent 
crystalline  mass,  and  in  loose  crystals.  Experiments  made  bv 
Dr.    Ohlmueller,    of  the    German    Health  Department,  showed 


CARBOLIC  ACID. 


219 


that  the  synthetic  acid  diminished  the  life  activity  of  the  bacteria 
experimented  on  rather  less  than  the  older  acid,  but  that  the 
difference  was  so  small  that  the  two  kinds  might  be  considered 
to  be  practically  of  the  same  value.  One  of  the  advantages 
claimed  for  synthetic  carbolic  acid  is  its  greater  solubility  in 
water,  thus  enabling  the  operator  to  use  it  in  greater  strength 
without  diminishing  its  causticity. 

Phenol  Sodique  (unofficial)  is  a  solution  of  sodium  carbolate,  and 
is  extensively  employed  in  dental  practice.  (See  Phenate  of 
Soda.)  It  is  composed  of  pure  melted  carbolic  acid,  5  parts ; 
solution  of  caustic  soda  (of  a  specific  gravity  of  1.332),  i  part; 
distilled  water,  5  parts.      Mix. 

Carbolate  of  Camphor  is  composed  of  carbolic  acid,  by  weight, 
one  part,  and  camphor,  by  weight,  three  parts. 

DENTAL  FORMULA. 


A  Lotion  for  Soft  and  Spotjgy  Gums. 

R .     Acidi  carbolici  .    .    .    gr.  xx 
Spirit!  rectificati  (alco- 
hol.)     3ij. 

Aquae  destillatse    .    .     ^  vj.      M. 
It  renders  the  gum  less  tender  and 
firmer. 


An  Antiseptic  Lotion  or  Injection. 

B .     Acidi  carbolici  ...     ^  ss 

Glycerini S'^v.     M. 

For  alveolar  abscess  and  ulcers  of 
mouth.  The  glycerine  modifies  the 
caustic  action  of  the  acid. 

A  Stimulant  and  Antiseptic  Lotion. 
Dr.  J.  Stock  EN. 

R.     Acidi  carbolici  .    .    .     ^] 

Glycerini ?iv 

Aquae ^^  x.        M. 

Useful  in  ulceration  of  the  gums  and 

mucous  membrane. 


For   Sensitive   Dentine  and  Alveolar 
Pvorrhcea. 


Dr.  J.  A.  Robinson. 


B- 


Acidi  carbolici  .    .    .     (cryst.) 
Potassae  caustic  .  aa  partes  equal. 
Misce,  by  triturating  in  a  mortar  un- 
til a  crystalline  paste  is  formed. 
SiGNA. — Apply    on    a    loosely   rolled 
twist  of  cotton  about  neck  of  tooth, 
for  alveolar  pyorrhoea.     It  is  known 
as  the  "  Robi7ison  Jiemedy." 


For   Alveolar  Pyorrhoea   (Pings'  Dis- 
ease) . 

R .     Acidi  carbolici  . 
Potassae  iodidi   . 
Zinci  chloridi 
Alcohol  absolut 
Aq.  destillatae    . 
01.  menthas  pip. 
Misce  et  filtra. 
SiGNA — As  an  injection  in  pus-pockets 
of  gum. 


nxxxv 

gr.v 

gr.xxv 

ITLxxv 


220 


DENTAL  MEDICINE. 


A  Disinfectant  Mouth  IVas/i. 
Dr.  J.  B.  Patrick. 
R.     Acidi  carbolici  (cryst.), 
Glycerini, 

Aquae  rosse  ....    .    tia  5  ij  M. 
SiGNA. — Five  to  eight  drops  in  a  wine- 
glass of  water. 

A  Stimulant  and  Antiseptic  Mouth 
IVash. 
R .     Acidi  carbolici  .    .    .    gtt.xx 

Glycerini ^iv 

Aqute 3  X         M. 

SlGNA. — To  be  used  as  a  gargle. 

For  Fetid  Perspiration. 
R.     Acidi  carbolici  ...    2  parts 

Glycerini 3  parts  M. 

For  Parasitic  Skin  Diseases. 
R.     Acidi  carbolici  .    .    .     gj 

Glycerini ^j.        M. 

Antiseptic  Solution  for  Washing  and 

Spraying  Wounds,  etc. 
R.     Acidi  carbolici  (cryst.)  partem  j 

Aquas part.  xxiv. 

SlGNA. — Dilute  the  above  solution  with 
equal  parts  of  water,  which  will 
make  it  equal  to  i  part  of  the  acid 
to  40  parts  of  water  ;  also  for  use  in 
disinfecting  instruments  and  sponges. 

For  Dry  Mouth. 
H.  J.  Fish. 
R.     Acidi  carbolici  .    .    .     gtt.x 

Glycerini ^j.         M. 

SiGNA. — Apply  on  palate  of  mouth 
with  a  soft  brush  3  times  a  day. 

For  Inhalation   in   Syphilitic  Ulcera- 
tions. 
R.     Acidi  carbolici  .    .    .     ^xxj 

Aquoe  destillatae    .    .     ^^  iij       M. 
SiGNA. — Inhale  the  vapor.    Antiseptic. 


A  Stimulant  and  Antiseptic  Injection. 
R.     Acidi  carbolici  ...     I  part 

Glycerini 30parts.M. 

Useful  as  an  injection  in  chronic 
forms  of  alveolar  abscess. 

For  Odontalgia. 
R .     Acidi  carbolici. 
Chloroform, 
Liquid  opii, 
Vel  morphine   hydro- 

chloratis iia  ^ij 

Tinclurse  benzoini     .  Jj.  M. 

SiGNA. — Apply  to  exposed  surface  of 
pulp,  on  cotton. 

A  Stimulant  and  Antiseptic  Lotion  or 

Injection. 

Percy  Boulton. 

R.     Acidi  carbolici  .    .    .     TTLvj 
Tincturse  iodi    .    .    .     TT]^.\lv 

Glycerini ^j 

Aquae  destillatae  ^  v,        M. 

For  inflamed  mucous  membrane,  and 
an  injection  for  chronic  alveolar  ab- 
scess; also  useful  in  acute  abscess 
after  the  use  of  more  powerful  escha- 
rotic  and  antiseptic  agents. 

For  Itching  of  the  Skin. 
R .  Acidi  carbolici  ....     5  ij 

Glycerini 1^] 

Aquae  rosae         ■    •    •     5  ^'0-    M- 
SiGNA. — To  be  applied  by  means  of  a 
sponge. 

The  following  preparation  is  recom- 
mended for  the  relief  of  odontalgia,  by 
Dr.  K.  W.  Millican  :— 

"  Melt  white  wax  or  spermaceti,  two 
parts,  and  when  melted  add  carbolic 
acid  crystals,  one  part,  and  chloral 
hydrate  crystals,  two  parts;  stir  well 
till  dissolved.  While  still  liquid,  im- 
merse thin  layers  of  carbolized  absorb- 


CHROMIC   ACID. 


221 


ent  cotton-wool,  and  allow  them  to 
dry.  When  required  for  use,  a  small 
piece  may  be  cut  off  and  slightly 
warmed,  when  it  can  be  inserted  into 
the  carious  cavity  of  the  tooth,  where 
it  will  solidify." 

For  Alveolar  Pyorrhoea  (^Riggs* 
Disease). 
R .     Acidi  carbolici  .    .    .    ^([y 
Spts.  vini  reclif  ...     gvj 
Aq.  menthie  pip.  .    .     ^  ij 

01.  anisi filj 

01.  cinnamon    .    .    .    fTLss.     M. 
SiGNA. — Apply  to  gum  with  camel's- 
hair  brush. 

An   Antiseptic  and  Disinfectant 
Dentifrice. 
J.  Stocken. 
R.     Acidi  carbolici  .    . 
Pulvis  ossis  sepiae  . 
Pulvis.radicis  iridis 
Creta  Preparatae    . 
Olei  caryophylli    .    .    gtt.iij     M. 


R 


gtt.iij 


For  a  Carbolized  Styptic. 
R.     Acidi  carbolici  .    .    .    x  parts 

Collodii c  parts 

Acidi  tannici  .    .    .    .    v  parts 
Acidi  benzoici    .    .    .    v  parts  M. 
It   coagulates   blood   and   albumen, 
and  cicatrizes  the  tissues. 


For  Chilblain. 

r. 

Acidi  carbolici  .    . 

7,) 

TincturiE  iodi     ,    . 

.^ii 

Acidi  tannici  .  .    .    . 

.^ij 

Cerate  Simplicis    . 

,^iv 

iat  unguentum. 

M. 


For  Odontalgia. 
R.     Collodii  (fle.xile)    .    .     gj 

Acidi  carbolici  .    .    .     3  ij         M. 
SiGNA. — Apply  to  surface  of  exposed 
and  painful  pulp. 

For  Odontalgia. 
R.     Acidi  carbolici  ...     ^ij 

Morphinse  acetatis  .  .    gr.xx.     M. 
SiGNA. — Apply  to  surface  of  exposed 
pulp,  on  cotton. 

Dressing  for  Root-  Canals  and 

Abscesses. 

Dr.  G.  V.  Black. 

R .     Acidi  carbolici  .    .    .     i  part 

Oleum  cassize    ...     2  parts 

Oleum  gaultheriae  .  .     3  parts  M, 

Dressing  for  Children'' s  Teeth, 
Dr.  L.  L.  Davis. 
R.     Acidi  carbolici  (cryst.)   ^j 
Oleum  cassise    ...     ^j 

Glycerini ^j 

Alcoholis ^ij        M. 

It  quickly  relieves  pain,  and  does 
not  nauseate. 


For   Pain   after  Extraction. 
First  wash  out  cavity  with  phenol-sodique,  then  apply  on  a  loosely  rolled 
pellet  of  cotton  the  following : 

R.         Acid,  carbolici  glacial 3;ij 

Liq.  potassje ^j 

Water 3  vj.      M. 

ACIDUM  CHROMICUM— CHROMIC  ACID. 
Formula. — H2Cr04. 

Derivation. —  Chromic  acid  is  obtained  in  the  form  of  brilliant, 
deep   red,  acicular  crystals,  by   the   reaction   of  strong  sulphuric 


222  DENTAL  MEDICINE. 


acid  upon  a  solution  of  bichromate  of  potash.  It  is  deliquescent, 
and  very  soluble  in  water  aad  alcohol,  forming  an  orange-yellow 
solution. 

Medical  Properties  and  Action — It  is  a  powerful  caustic,  decom- 
posing the  tissues  by  rapid  oxidation  ;  and  although  it  is  very  slow 
and  gradual  in  its  action,  yet  it  is  deeply  penetrating  and  when  its 
action  ceases,  sesquioxide  of  chromium  remains.  So  destructive 
is  its  effect,  that  small  animals  are  dissolved  entirely,  bones  and 
all,  by  it,  in  fifteen  or  twenty  minutes.  On  account  of  its  pen- 
etrating deeply,  without  much  pain,  care  is  necessary  in  its  use  ; 
and  when  used  as  a  caustic,  the  surrounding  tissues  should  be 
well  protected.  The  part  on  which  it  acts  first  becomes  yellow, 
then  brown,  and  ultimately  black,  and  the  eschar  is  detached  in 
from  twenty-four  to  forty-eight  hours.  It  is  a  powerful  oxidizer, 
and  gives  up  its  oxygen  readily  to  organic  matter,  which  it  thus 
dissolves.  When  in  solution,  more  or  less  diluted,  its  action  can 
be  modified,  according  to  the  eff'ect  desired. 

Therapeutic  Uses. — Chromic  acid  is  not  given  internally.  In 
the  form  of  paste,  or  solution  with  water,  it  is  a  valuable  caustic 
in  cancerous  and  other  ulcerations,  malignant  growths,  hem- 
orrhoids, warts,  etc.  Chromic  acid  has  been  employed  with  good 
eff^ect  in  syphilitic  sores,  cases  of  secondary  syphilis,  deep  and 
jagged  ulcers  of  the  tongue,  and  ulceration  of  inside  of  the  cheek, 
mucous  tubercles  and  condylomata.  It  has  also  been  employed 
in  the  treatment  of  granular  ophthalmia,  uterine  hemorrhage, 
uterine  catarrh,  etc.  It  causes  less  pain  than  nitric  acid  and 
other  caustics,  and  should  never  be  applied  to  a  surface  to  be 
cauterized  in  a  layer  deeper  than  a  line  in  thickness.  For  re- 
moval of  warts,  etc.,  it  is  employed  in  a  solution  of  lOO  grains 
to  the  ounce  of  distilled  water. 

Dental  Uses. — In  dental  practice  chromic  acid  has  been  em- 
ployed for  obtunding  sensitive  dentine;  but  its  most  valuable  ap- 
plication is  for  the  removal  of  tumors  and  morbid  growths  upon 
the  gums,  fungous  growths  of  tooth  pulp,  etc.  When  applied  to 
any  part  of  the  mouth,  the  surrounding  parts  should  be  carefully 
protected  by  folds  of  lint  or  strips  of  adhesive  plaster,  or  the  rub- 
ber dam.     A  glass  rod,  or  a  gold  or  platinum  wire,  should  be  used 


CRESYLIC    ACID.  223 


for  its  application.  It  is  also  useful  in  ulceration  and  recession 
of  the  gums,  beginning  the  treatment  with  a  weak  solution,  and 
gradually  increasing  the  strength.  It  is  sometimes  combined  with 
glycerine,  in  which  case  the  latter  must  be  added  to  the  acid  drop 
by  drop,  in  order  to  avoid  explosion.  As  an  obtundent  it  is  use- 
ful in  the  strength  of  a  solution  i  in  40,  for  relieving  the  pain  of 
psoriasis  and  syphilitic  affections  of  the  tongue. 

DENTAL  FORMULA. 

For    Secondary     Syphilitic     Ulcers,    and   Ulceration    of    Mucous 
Membrane  of  Mouth  and  Tongue. 

li .     Acidi   chromici gi".x 

Aquae Jj.         M. 

SiGNA. — Paint  the  diseased  parts  3  or  4  times  a  day,  with  a  cam- 
el's-hair  brush  dipped  in  the  solution. 

CRESOL— CRESYLIC  ACID— ACIDUM  CRESYLICUM. 

Formula.— Q,Yif:>=Z^Y{l(ZW.^.OYi. 

Cresylic  Acid  is  an  antiseptic  and  germicide  upon  the  different 
kinds  of  pathogenic  organisms.  It  is  a  colorless  liquid  having 
the  odor  of  creasote.  It  boils  at  203°,  and  is  slightly  caustic. 
It  is  soluble  in  water,  quite  soluble  in  alcohol,  glycerine,  and  water 
of  ammonia,  and  very  soluble  in  both  of  the  latter.  When  injected 
into  rabbits  it  produced  toxic  symptoms,  but  to  cause  death  a 
dose  four  times  greater  than  that  of  carbolic  acid  was  required. 
It  has  a  marked  effect  in  retarding  the  fermentation  of  urine  and 
milk.  Experiments  on  cultures  of  the  various  pathogenic  micro- 
organisms demonstrated  that  cresylic  acid  is  a  powerful  antisep- 
tic and  germicide,  and  quicker  in  its  action  than  carbolic  acid  or 
its  congeners. 

ACIDUM  GALLICUM— GALLIC  ACID. 

Formula. — C^  HgO- . 

Derivation. — Gallic  Acid  is  obtained  from  galls  by  exposing 
the  powder,  in  water,  to  the  action  of  the  air,  at  a  temperature 
of  between  60°  and  70°  F.,  when  the  acid  is  deposited  in  the 
form  of  small,  silky,  almost  colorless  crystals,  possessing  a  slightly 


224  DENTAL  MEDICINE. 


acid  and  astringent  taste.  Gallic  acid  is  slightly  soluble  in  cold 
water,  and  freely  soluble  in  hot  water,  glycerine  or  alcohol. 

Galls,  from  which  gallic  acid  is  prepared,  are  the  excrescences 
caused  by  the  punctures  and  deposited  ova  of  a  hymenopterous 
insect  on  the  twigs  of  the  gall  oak  (^ercus  Infectorid). 

Source. — Galls  are  obtained  from  Asia  Minor  and  Persia. 

Medical  Properties  and  Action  of  Galls. — Powerfully  astringent, 
this  property  depending  upon  the  presence  of  tannic  and  gallic 
acids,  as  they  contain  35  per  cent,  of  tannic  and  5  per  cent,  of 
gallic  acids.  The  powder,  which  is  obtained  from  the  small, 
round,  dark-blue  or  lead-colored  excrescences,  is  of  a  light  yel- 
lowish-gray color,  inodorous  and  of  a  bitter  taste. 

Galls  are  used  in  various  forms,  such  as  powder,  tincture,  in- 
fusion, ointment,  etc. 

Therapeutic  Uses. — Galls  are  employed  in  the  treatment  of 
chronic  diarrhcea,  dysentery,  leuchorrhoea,  chronic  gonorrhoea  and 
gleet,  diseases  of  the  uterus  and  intermittent  fevers,  and  externally 
in  hemmorrhagic  disorders,  hemorrhoids,  relaxation  of  uvula,  hy- 
pertrophy of  the  tonsils,  etc. 

Gallic  acid  is  given  directly  for  internal  hemorrhage. 

Dose. — Of  powdered  galls,  gr.  x  to  gr.  xx.  The  ointment  is 
composed  of:  powdered  galls,  gr.  Ixxx  ;  benzoated  lard,  .^j.  It 
is  combined  with  opium  in  the  proportion  of  ointment  of  galls, 
5j  ;  powdered  opium,  gr.  xxxij. 

Medical  Properties  and  Action. — Gallic  acid  is  a  powerful  as- 
tringent for  arresting  hemorrhage  in  which  the  bleeding  vessels 
must  be  reached  through  the  circulation.  It  is  also  a  valuable 
styptic  in  cases  of  hemorrhage  depending  on  a  hemorrhagic  dia- 
thesis, and  in  the  form  of  a  gargle  it  is  very  serviceable  in  acute 
inflammations  of  mucous  membranes.  It  is  also  a  strongly  de- 
odorizing agent ;  and,  like  tannic  acid,  it  is  capable  of  taking 
oxygen  from  the  blood  globules.  Internally  employed  it  produces 
constipation,  which  may  be  prevented  by  an  occasional  aperient. 
Although  it  is  weaker  than  tannic  acid,  yet  its  properties  are  very 
similar.  It  is  supposed  to  be  converted  into  tannic  acid  in  the 
blood. 

Therapeutic    Uses. — Gallic   acid   is  employed  in  the  treatment 


GALLIC   ACID. 


225 


of  hemorrhagic  diseases,  in  their  chronic  stages  especially,  such 
as  hemoptysis,  hemorrhage  from  ulcer  of  the  stomach,  hematem- 
esis  and  hematuria,  atonic  menorrhagia ;  also,  for  the  profuse 
perspirations  and  excessive  expectoration  of  phthisis,  for  albu- 
minuria, dyspepsia,  chronic  diarrhoea  and  gastric  irritation  in  chil- 
dren, gonorrhoea,  gleet,  etc.  It  is  also  administered  in  cases  of 
alveolar  hemorrhage. 

Dose. — Of  gallic  acid,  gr.  ij  to  gr.  v,  in  pill,  every  two  or  three 
hours. 

Glycerite  of  gallic  acid  {Glyceritum  Acidi  Gallic'i)^  for  external 
use,  is  composed  of  gallic  acid,  .^j  ;  glycerine,  .5iv. 

Ointment  of  galls  (  XJnguentum  Galla)  is  composed  of  galls  in 
fine  powder,  .5j ;  lard,  420  grains. 

Dental  Uses. — Powdered  gall  is  useful  as  a  styptic  in  super- 
ficial hemorrhages  from  the  gums  and  mucous  membrane  ;  also 
in  inflamed  and  ulcerated  condition  of  mucous  membrane,  and  in 
relaxation  of  the  uvula.  Gallic  acid,  in  the  form  of  a  gargle,  is 
employed  in  acute  inflammations  of  mucous  membrane,  as  astrin- 
gent and  antiseptic,  and  in  hemorrhages  from  mucous  surfaces  de- 
pending upon  a  hemorrhagic  diathesis. 

For  hemorrhage  following  the  extraction  of  teeth.  Dr.  Bar- 
tholomew claims  that  one  teaspoonful  of  gallic  acid  in  a  glass  of 
water,  internally  administered,  never  fails. 


DENTAL  FORMULA. 


/"W  Acute  Tonsilitis  and  Inflammation 

of  the  Mucous  Membrane 

of  the  Mouth. 

li .     Acidi  gallici gr.  xl 

Liq.  sodae  chlorinatse    .  ^ij 

Glycerini ^  jj 

Aquas  destillatae    ...  J  viij.  M. 
SiGN'A. — To   be  used  as  an  antiseptic 
and  astringent  gargle. 

For  Relaxation  of  C\'ula  and  Hyper- 
trophy of  Tonsils. 

R.     Infusi  gall?e ^vj 

Aluminis gr.  xl.  M. 

SiGNA. — Use  as  a  gargle. 
15 


An    Internal   Astringent   in    Hemor- 
rhagic Affections. 
R.     Acidi  gallici _^j 

Glycerini ?iv. 

Aquas  destillatae  .    .    .    .  ^  vj.  M. 
SiGNA. — Take  ^j  as  a  dose. 

For  Alveolar  Hemorrhage. 
Dr.  C.  W.  Glassingtox. 

Acidi  gallici gr.  xx. 

Acidi  sulphurici   ....   tj. 

Tinct.  opii 31  ss. 

Aquae ^vj. 

SlGNA. — Two   tablespoonfuls  every   2 
hours  until  bleeding  stops. 


226  DENTAL  MEDICINE. 


An    Internal  Astringent  for   Dental        For  an  Astringent  Gargle  or  Lotion. 

Hemorrhage. 
„  .  R .     Pulvens  gallse    .    .    .   ?  ss 

Otto  Arnold.  ^  ^  ^. 

U.     Acidi    gallici ^j.  ^        ■'■ 

Aquae  cinnamon  .    .    .    .  J  ij.  M.  SiGNA. — As  a  gargle  or  lotion  in  in- 

SiGNA. — A  teaspoonful  every  hour  un-  flamed    or    ulcerated    condition    of 

til  bleeding  is  arrested.  mucous  membrane  and  gums. 

ACIDUM  HYDROBROMICUM— HYDROBROMIC  ACID. 

Formula. — H  Br. 

Derivation. — Diluted  Hydrobromic  Acid  is  prepared  by  adding 
ten  per  cent,  of  absolute  hydrobromic  acid  to  ninety  per  cent,  of 
water.  It  is  a  clear,  colorless  liquid,  having  no  odor,  but  a  de- 
cidedly acid  taste  and  an  acid  reaction. 

Medical  Properties  and  Therapeutic  Uses. — Hydrobromic  acid  is 
often  substituted  for  the  bromides  on  account  of  its  possessing 
many  of  their  properties.  It  is  employed  in  cerebral  disorders 
from  overexertion,  epilepsy,  spasmodic  cough,  angina  pectoris, 
affections  of  the  heart,  as  it  diminishes  its  action,  to  relieve  the 
symptoms  of  quinine,  and  also  of  morphine,  migraine  or  sick 
headache,  neuralgia,  spasmodic  asthma,  etc. 

Dose. — TTLxx  to  .5ij. 

Dental  Uses. — Diluted  Hydrobromic  Acid  may  be  employed  in 
facial  neuralgia,  infantile  convulsions  due  to  teething,  and  to 
lessen  the  irritability  of  the  fauces  when  impressions  for  obturators 
and  artificial  palates  are  being  taken. 

ACIDUM  HVDROCHLORICUM— HYDROCHLORIC  ACID. 
MURIATIC    ACID ACIDUM    MURIATICUM. 

Formula. — HCl.     Sp.  gr.,  1.16. 

Derivation. — Hydrochloric  or  Muriatic  Acid  is  obtained  by  the 
action  of  sulphuric  acid  on  a  solution  of  chloride  of  sodium  or 
common  salt.  When  pure,  it  is  a  transparent,  colorless  liquid, 
but  when  contaminated  with  chlorine,  iron  and  other  substances, 
it  has  a  yellow  color.  It  emits  a  dense,  white  vapor,  with  a 
pungent  odor  and  a  corrosive  taste,  being  an  active  poison.  The 
antidote  is  magnesia  or  soap. 

Medical  Properties  and  Action. — The  strong  acid  is  a  powerful 
caustic  and  escharotic  ;  also   disinfectant   and  fumigant,  but  in- 


HYDROCHLORIC    ACID.  227 

ferior  in  its  disinfectant  properties  to  those  of  chlorine.  For 
internal  use  the  dilute  acid,  which  is  tonic,  refrigerant  and  as- 
tringent, is  employed,  acidum  hydrochloricum  dilutum, — diluted 
hydrochloric  acid,  which  is  prepared  by  diluting  the  strong  acid 
so  that  four  ounces  of  the  acid  are  contained  in  a  pint  of  diluted 
acid.  It  is  of  a  deep  yellow  color,  and  emits  the  odor  of  chlorine, 
which  is  its  principal  constituent. 

Therapeutic  Uses. — The  dilute  hydrochloric  acid  is  internally 
employed  in  the  treatment  of  calculous  affections,  gout,  atonic 
dyspepsia,  typhus  and  typhoid  fevers,  continued  fevers  of  child- 
hood, syphilis,  chronic  whooping-cough,  phthisis,  etc.,  and  ex- 
ternally in  diphtheria,  ulcerated  sore  throat,  cynanche  maligna,  etc. 

Dose. — Of  dilute  hydrochloric  acid,  TTLx  to  Tllxxx,  freely 
diluted;  otherwise,  when  swallowed,  it  is  highly  irritant  and 
corrosive. 

Dental  Uses. — The  strong  acid  is  employed  in  the  dental 
laboratory  for  dissolving  zinc,  in  the  preparation  of  flux  for 
soldering  certain  metals. 

The  strong  acid  is  also  employed  as  a  local  application  in 
gangrenous  stomatitis  or  cancrum  oris,  for  arresting  the  ulcerative 
process  ;  but  care  is  necessary  in  its  use,  on  account  of  its  pow- 
erful action.  Combined  with  equal  parts  of  glycerine  it  is  use- 
ful in  inflammation  and  ulceration  of  the  oral  mucous  membrane ; 
also,  the  same  combination  in  cases  of  sloughing  will  induce  a 
healthy  form  of  inflammation,  and  to  limit  its  application  to  the 
parts  on  which  it  is  to  act,  collodion  may  be  applied.  For  mild 
cases  of  inflammation  it  may  be  diluted  with  an  equal  amount  of 
honey. 

In  aphthous  ulcerations  of  the  mouths  of  children,  it  is  often 
a  useful  application. 

DENTAL  FORMULA. 
For  Aphtha.  For  Chronic  Injlammation  of  Mucous 

Membrane  and  Gums. 
R .     Acidi  hydrochlorici .  I  part  R .     Acidi  hydrochlorici  di- 

Mellis    .    .     •   .    .    .  8  parts.     M.  ^"ti Tttx 

Infusi  cinchonas     .    .  f  5  iv 

SiGNA. — Apply  with  a  camel-hair  pen-  Mellis f ^j.        M. 

cil.  Fiat  gargarysma. 


228  DENTAL  MEDICINE. 


For  Ulceration  of  Mucous  Membrane,  For  Scorbutic  Gums, 

R .     Acidi  hydrochlorici  di 
R,     Acidi  hydrochlorici  di-  j^^j  ^^ 

l"t' ■    SiJ  Mellis, 

Glycerini 31V  Aquae  rosae  .    .    .    .    aii  f^j.    M. 

Aqu^  destillatae    .    .  5x.  M.       SiGNA.-Apply  with  a  camel-hair  pen- 

SiGNA. — To  be  used  as  a  gargle.  cil  3  or  4  times  a  day. 

ACIDUM  NITRICUM— NITRIC  ACID. 
AQUA    FORTIS. 

Formula. — HNO3.     Sp.  gr.,  1.420. 

Derivation. — Nitric  acid  is  obtained  by  the  action  of  sulphuric 
acid  upon  nitrate  of  potash  or  soda.  When  strong  and  pure  it 
is  colorless,  but  on  account  of  the  presence  of  nitric  peroxide  it 
is  generally  of  a  yellow  color,  and  emits  acrid,  corrosive  fumes. 

Medical  Properties  and  Physiological  Action. — Pure  nitric  acid  is 
a  powerful  caustic  and  escharotic,  and  leaves  a  permanent  stain 
on  the  cuticle.  It  is  not  employed  in  its  concentrated  form  in- 
ternally, but  externally,  as  an  escharotic  to  destroy  warts  and 
stimulate  sluggish  sinuses ;  in  a  diluted  form  it  is  employed  as  an 
astringent  wash  or  gargle.  The  antidotes  in  cases  of  poisoning 
are  magnesia  or  soap,  and  mucilaginous  drinks. 

Therapeutic  Uses. — The  strong  acid  is  employed  externally  in 
hospital  gangrene,  and  phagedenic  ulcerations ;  hemorrhoids  and 
painful  hemorrhoidal  tumors,  syphilitic  condylomata,  syphilitic 
sore  throat,  malignant  ulcers,  obstinate  skin  diseases,  etc. 

Diluted  Nitric  Acid. — Jcidum  Nitricum  Dilutum  contains 
three  ounces  of  acid  in  every  pint  of  the  diluted  acid. 

Medical  Properties  and  Physiological  Action. — It  is  an  antalka- 
line,  alterative  tonic  and  refrigerant,  and  has  a  very  direct  action 
on  the  liver,  and  if  its  use  is  continued  for  a  long  time  it  causes 
salivation  and  loosening  of  the  teeth.  It  coagulates  albumen. 
Like  all  mineral  acids,  it  injures  the  teeth,  when  brought  in  con- 
tact with  them ;  hence,  proper  care  should  be  taken  to  prevent 
such  action,  such  as  the  use  of  alkaline  gargles  before  and  after 
taking  the  acid  into  the  mouth,  which  should  be  done  through  a 
glass  tube  or  quill.  As  a  tonic  it  is  advantageously  employed 
during  convalescence  and  inflammation,  and  in  cachexia  follow- 


PHOSPHORIC   ACID.  229 


ing  acute  disease  or  habits  of  intemperance.  It  is  also  employed 
as  an  alterative  after  a  long  use  of  mercury,  as  it  increases  the 
strength  and  improves  the  tone  of  the  system.  It  is  also  val- 
uable as  a  disinfectant,  but  inferior  to  chlorine.  It  is  not  as 
agreeable  to  the  stomach  as  diluted  sulphuric  acid. 

Therapeutic  Uses. — Dilute  nitric  acid  is  employed  in  the  treat- 
ment of  calculous  disease,  syphilis,  chronic  hepatitis,  chronic 
diarrhcea,  constipation,  chronic  affections  of  the  spleen,  chronic 
rheumatism,  cardialgia,  whooping-cough,  intermittent  fevers,  etc. 

Dose. — Of  diluted  nitric  acid,  gtt.  ij-xv,  three  times  a  day, 
diluted  with  water,  and  taken  through  a  tube  to  protect  the  teeth. 

Dental  Uses. — The  strong  acid,  when  mixed  with  two  parts  of 
hydrochloric  acid,  is  a  solvent  for  gold,  and  is  known  as  aqua 
regia.  It  is  also  employed  as  one  of  the  most  effectual  caustics 
in  cancrum  oris,  the  constitution  being  supported  and  quinine 
given  at  the  same  time;  also  for  malignant  ulcers  of  the  mouth, 
and  for  devitalizing  pulps  of  teeth  when  nearly  exposed  by 
mechanical  abrasion,  care  being  observed  that  the  part  of  the 
surface  immediately  over  the  pulp  is  touched  with  the  acid,  and 
the  neighboring  parts  protected  ;  it  is  a  painful  operation,  how- 
ever, and  nitrate  of  silver  is  preferable. 

DENTAL  FORMULA. 

J^or  Sloug/iiiig  and  III-  Conditioned  Ulcers. 

R.         Acidi  nitrici 1TLl-lx 

Aquae Oj.  M. 

SiGNA. — Apply  with  a  camel-hair  brush. 

ACIDUM  PHOSPHORICUM— PHOSPHORIC  ACID. 

AciDUM  Phosphoricum  Dilutum. — Diluted  Phosphoric  Acid 
is  the  principal  form  in  which  phosphoric  acid  is  employed  in 
medicine. 

Formula. —  HgPO^.     Sp.  gr,,  1.056. 

Derivation. — Phosphorus,  a  non-metallic  element,  obtained 
from  bones,  is  a  translucent,  nearly  colorless,  wax-like  solid, 
without  taste,  and  emitting  white  vapors  when  exposed  to  the 
air.     Sp,  gr.,  1.8. 


230  DENTAL  MEDICINE. 

It  is  insoluble  in.  water,  but  soluble  in  ether  and  in  hot  oil  of 
turpentine,  and  has  a  peculiar  smell.  It  is  nervine,  tonic  and 
stimulant,  and  in  over-doses,  poisonous.  The  vapor  is  irritating 
to  the  conjunctiva  and  bronchial  mucous  membrane. 

Diluted  Phosphoric  Acid  is  prepared  by  boiling  phosphorus  with 
nitric  acid  and  distilled  water  until  it  is  dissolved,  evaporating 
and  rediluting  it.  It  may  also  be  obtained  by  dissolving  an  ounce 
of  glacial  phosphoric  acid  in  three  ounces  of  distilled  water, 
afterward  adding  forty  grains  of  nitric  acid,  boiling  to  a  syrup, 
and  diluting  with  water  until  the  solution  measures  twelve  and  a 
half  ounces. 

Medical  Properties  and  Physiological  Action. — It  is  tonic  and  re- 
frigerant, and,  in  large  doses,  is  a  powerful  stimulant  to  the  nerv- 
ous and  vascular  systems.  It  can  be  detected  in  the  blood, 
owing  to  its  absorption,  and,  in  large  doses,  is  an  irritant  poison. 

Therapeutic  Uses. — Diluted  phosphoric  acid  is  employed  in 
scrofula,  dropsy,  hemoptysis,  calculous  disease,  diabetes  and  car- 
dialgia.  Externally,  it  has  been  employed  as  a  local  application 
in  the  treatment  of  caries  of  the  bones  and  osseous  tumors. 

Dose. — Of  dilute  phosphoric  acid,  gtt.  ij-xv,  diluted  in  sugar 
and  water. 

Dental  Uses. — As  a  local  application  in  the  treatment  of  caries 
of  the  maxillary  bones  and  osseous  tumors  of  the  jaws.  Inter- 
nally, it  has  been  administered  with  a  view  of  supplying  a  defi- 
ciency of  phosphoric  acid  in  the  teeth.  (^See  Hypophosphites  of 
Lime^ 

DENTAL    FORMULAE. 

For    Caries   of  the  Maxillary   Bones  For  Ulcers  Over  Carious  Bones. 

and  Osseous  Tumors  of  the  '7aw.  -n        .    •  ,•     i        i      •  •     , 

■'         -^  JJ.     Acicli  phosphonci  gla- 

R.     Acidi  phosphor,  dilut.  .  I  part  "^^'^ ^J 

Aquse  destillatse  8  to  lo  parts.    M.  Aquae  destillatae  .    .    .  f  5  viij 

SiGNA.— Apply  as   a   lotion   or   injec-  ^''''^  Solutio. 

tion.  SiGNA. — To  be  applied  on  compresses 


Phosphoric  Acid  in  the**Anhydrous  State  consists  of  one  equiva- 
lent of  phosphorus  to  five  equivalents  of  oxygen  (PO5),  and  it 


PHOSPHORIC  ACID.  231 


is  obtained  by  the  direct  union  of  its  constituents,  which  takes 
place  when  phosphorus  is  burned  in  perfectly  dry  oxygen  gas. 

Thus  procured  it  is  in  the  form  of  a  white  amorphous  powder, 
extremely  deliquescent,  volatilizable  at  a  red  heat,  and  assumes, 
when  it  cools,  after  fusion,  a  vitreous  appearance. 

Glacial  Phosphoric  Acid^  or  monohydrated  phosphoric  acid,  con- 
centrated phosphoric  acid,  is  readily  obtained  from  calcined  bones, 
by  first  heating  them  with  sulphuric  acid,  which  produces  an 
insoluble  superphosphate  of  lime ;  then  dissolving  out  the  latter 
salt,  and  saturating  it  with  carbonate  of  ammonia,  which  gener- 
ates phosphate  of  ammonia  in  solution,  and  finally  obtaining  the 
phosphate  of  ammonia  by  evaporating  it  to  dryness,  and  then 
igniting  it  in  a  platinum  crucible.  The  ammonia  and  all  of  the 
water,  except  one  equivalent  for  each  equivalent  of  the  acid,  are 
driven  off,  and  the  glacial  phosphoric  acid  remains,  the  formula 
of  which  is  HO,?©^,  and  contains  11.2  per  cent,  of  water.  It 
is  a  white,  transparent  fusible;  solid,  generally  in  the  form  of 
sticks,  inodorous  and  sour  to  the  taste.  It  slowly  deliquesces, 
and  is  sparingly  soluble  in  water,  but  freely  soluble  in  alcohol. 

Dental  Uses. — Glacial  phosphoric  acid  and  white  oxide  of  zinc 
formed  into  an  anhydrate,  give  the  plastic  material  for  filling 
teeth,  known  as  oxyphosphate  of  zinc.  The  powder  or  solid 
portion  of  this  preparation  is  prepared  by  packing  pure  oxide  of 
zinc  in  a  clay  crucible  and  subjecting  it  to  almost  a  white  heat 
for  two  hours,  when  it  will  have  been  reduced  in  bulk  fifty  per 
cent.  It  is  then  pulverized  in  a  mortar  to  an  almost  impalpable 
powder.  The  burning  of  the  oxide  of  zinc  colors  it  to  a  light 
yellow,  and  it  is  now  in  a  condition  for  use,  and  may  be  kept  in 
a  covered  vessel  for  any  length  of  time. 

The  liquid  portion  of  this  filling  material  being  glacial  phos- 
phoric acid,  is  prepared  by  dissolving  the  acid  in  pure  water  until 
a  saturated  solution  is  obtained,  when  it  is  reduced  by  boiling  in 
a  glass  vessel  until  it  is  of  the  consistency  of  glycerine,  in  which 
operation  it  loses  one-third  in  bulk.  It  is  now  ready  for  use,  and 
must  be  kept  in  a  close  glass-stoppered  bottle. 

Formulae  for  Fletcher's  and  Weston's  preparations  of  oxyphos- 
phate of  zinc  filling  materials  : 


232  DENTAL  MEDICINE. 


FLETCHER  S. 

Fluid,  Solid. 

Phosphoric  acid.  Basic  oxide  of  zinc. 

Phosphate  of  alumina. 

Weston's. 

Fluid.  Solid. 

Phosphoric  acid.  Basic  oxide  of  zinc — 80  per  cent. 

(See  Oxide  of  Zinc ^  Silicate  of  alumina — 20  "       " 

Medicated  Oxyphosphate  Fillings. — Dr.  Chas.  B.  Atkinson 
claims  the  following  advantages  for  such  filling  materials : 

First. — A  remedial  agent  in  constant  contact  with  the  walls  of 
the  cavity. 

Second. — Germicidal  action  of  the  filling  on  the  tissue  with 
which  it  comes  in  contact. 

Third. — A  neutral  influence  resisting  solution. 

Fourth. — Increased  hardness,  varying  somewhat  with  the  agent 
used.  The  medicaments  for  oxyphosphate  fillings  are:  i. 
Creasote  and  oil  of  cloves,  equal  parts ;  2.  Eugenol ;  3.  Del- 
iquesced Carbolic  acid  ;  4.  Oil  of  cinnamon  ;  5.  Oil  of  cloves  ; 
6.  Creasote,  pure ;  7.  Creasote,  oil  of  cloves  and  iodoform  ; 
8.  Creolin ;  9.  Campho-phenique ;  lO.  Potassium  chlorate 
(powdered);  11.  Salicylic  acid;  12.  Camphor  (pulverized); 
13.  Stick  sulphur  (pulverized);  14.  Iodoform;  15.  Oil  of 
wintergreen.  The  first  seven  have  been  fairly  tested  by  Dr.  At- 
kinson and  were  found  to  be  equal  in  durability,  manipulative 
qualities  and  time  of  setting.  He  employs  them  also  in  retaining 
inlays,  in  setting  retaining-fixtures  in  pyorrhoea  cases,  in  setting 
crowns,  etc.  In  capping  pulps  he  always  employs  a  mixture  of 
oxide  of  zinc,  creasote  and  oil  of  cloves,  and  adds  a  remedial 
agent  to  the  oxyphosphate  filling.  He  employs  mostly  the  first 
named  on  the  list.  If  the  medicament  is  a  liquid  he  adds  about 
an  equal  quantity  of  the  medicament  and  phosphoric  acid  ;  if  a 
powder,  about  equal  parts  of  the  medicament  and  oxide.  The 
proportions  may  be  varied  as  required.  The  average  time  of  set- 
ting is  about  ten  minutes. 


SALICYLIC   ACID.  233 


ACIDUM  SALICYLICUM— SALICYLIC  ACID. 

Formula.— HCjH.O,. 

Derivation. — Salicylic  Acid  is  obtained  by  combining  carbolic 
acid  with  caustic  soda,  and  subjecting  this  compound  to  dry  car- 
bonic acid  under  the  influence  of  heat,  the  portion  of  salicylate 
of  sodium  remaining  behind  after  the  carbolic  acid  distills  over 
being  saturated,  in  the  form  of  a  hot,  aqueous  solution,  with 
muriatic  acid,  which  liberates  the  salicylic  acid  in  small  crystals. 
The  crystals  are  washed,  dissolved  in  hot  water,  and  by  re-crys- 
tallization, obtained  in  the  form  of  a  powder  of  a  light  brown 
color,  which  is  then  bleached  until  it  is  quite  white;  but  most  of 
that  sold  is  of  a  light  cream-color  with  a  reddish  tinge.  The 
coloring  matter,  however,  which  is  present,  does  not  interfere 
with  its  efficacy.  It  is  sometimes  obtained  from  the  product  of 
plants,  such  as  wintergreen.  It  has  no  smell,  a  slight  taste,  and  is 
soluble  in  alcohol  and  ether  and  in  hot  water  and  glycerine.  It 
can  also  be  obtained  from  salicin,  the  vegetable  principle  existing 
in  willow,  poplar,  etc.,  and  from  oil  of  gaultheria  (wintergreen) 
and  from  spiraea  ulmariae  (meadow  sweet). 

Medical  Properties  and  Physiological  Action. — Salicylic  acid  is  a 
powerful  antiseptic,  and  is  said  to  be  as  effective  in  small  quanti- 
ties as  any  other  antiseptic,  in  arresting  putrefactive  and  fer- 
mentative processes.  When  properly  reduced  in  strength  it  causes 
no  pain  or  irritation  in  the  parts  to  which  it  is  applied.  It  will 
destroy  minute  organisms,  and  a  small  quantity  will  arrest  vinous 
fermentation  and  prevent  the  decomposition  of  animal  fluids. 
Although  free  from  any  poisonous  action  when  administered  in  a 
reasonable  quantity,  yet  in  large  doses  it  will  cause  nausea  and 
vomiting.  It  is  thought  to  combine  with  the  soda  of  the  blood, 
where  it  is  present  as  a  salicylate.  It  has  little  or  no  affinity  for 
cold  water;  but  the  addition  of  certain  alkaline  salts,  such  as 
sodium  phosphate,  increases  its  solubility.  Combined  with  sul- 
phite of  sodium,  which  is  also  antiseptic,  and  water,  a  solution  is 
formed  which  is  free  from  irritating  properties  and  especiallv  ap- 
plicable to  the  treatment  of  zymotic  diseases.  Glycerine  warmed 
will  dissolve  A  its  weight  of  salicylic  acid,  and  the  solution  may 
then  be  diluted  with  water  to  any  desirable  extent. 


234  DENTAL  MEDICINE. 


Therapeutic  Uses. — It  is  employed  in  fevers  as  an  antipyretic 
or  febrifuge ;  also  for  the  same  purpose  in  acute  rheumatism, 
pneumonia,  phthisis,  diphtheria,  etc.  Externally  it  is  employed 
as  a  disinfectant  and  deodorizer,  many  preferring  it,  on  account  of 
its  freedom  from  odor,  to  carbolic  acid.  It  is  also  employed  as  a 
local  application  in  eczema  of  the  head  and  face,  syphilitic  ulcers, 
and  to  cancer,  gangrenous  and  sloughing  wounds,  in  the  form  of 
powder,  and  as  an  ointment  for  burns. 

Salipyrine. — Prof.  Dr.  von  Hosengeil  (Bonn,  Germany)  claims 
that  the  action  of  antipyrine  in  such  cases  of  influenza  which 
show  no  rise  of  temperature  is  that  of  a  cardiac  poison.  Salicyl 
and  quinine  have  also  such  action.  By  combining  salicylic  acid 
and  antipyrine  he  claims  to  have  found  a  preparation  which  he 
names  salipyrine^  which  has  proven  itself  to  be  a  most  excellent 
specific  anti-influenzic  remedy  in  just  such  cases.  The  dose  he 
employs  is  from  15  to  30  grains. 

Dose. — Of  salicylic  acid,  gr.  x  to  gr.  xx  or  xxx. 

Dental  Uses. — Salicylic  acid  is  employed  in  the  treatment  of 
suppurating  and  gangrenous  pulps  of  teeth,  in  the  form  of  the 
dry  powder  introduced  into  the  pulp  canals  and  permitted  to  re- 
main for  several  days.  An  ethereal  solution  of  salicylic  acid,  in- 
troduced on  a  small  piece  of  punk,  has  also  been  employed  for 
the  same  purpose,  where  it  is  difficult  to  introduce  the  dry  pow- 
der ;  the  ether  volatilizes  in  a  few  minutes.  Salicylic  acid  is  also 
employed  with  advantage  in  inflamed  conditions  of  the  mucous 
membrane  of  the  mouth  and  gums,  and  in  the  treatment  of 
aphthae,  thrush  and  other  ulcers,  in  the  form  of  a  solution.  For 
such  purposes  its  combination  with  powdered  cassia  or  cinna- 
mon, equal  parts,  is  recommended,  to  be  applied  with  a  soft 
brush.  Salicylic  acid  has  also  been  found  efficacious  in  all  in- 
flammatory conditions  resulting  from  decaved  and  dead  teeth  and 
roots.  It  has  also  been  recommended  as  a  dentifrice,  in  the 
form  of  an  alcoholic  solution  of  the  acid  perfumed  with  oil  of 
gaultheria ;  but  its  use  for  such  a  purpose  is  questioned,  on  ac- 
count of  its  softening  effect  upon  the  tooth  structure.  As  tannic 
acid  interferes  with  the  action  of  salicylic  acid,  these  agents 
should  not  be  used  in  combination. 


SULPHURIC   ACID.  235 


DENTAL    FORMULA. 
A  Disinfectant  Mouth    PVask.  Signa. — Add  i  or  2  drachms  to  half  a 

„        .    -J-       1-     1-  •  .  pint  of  warm  water, 

JJ.     Acidi  salicylici  .    .     l  part  "^ 

Sodii  phosphas  .    .     3  parts  ^.^^   IVarts. 

Aquae  destillatse  .     30  parts.     M. 

SiGNA.— Use  as  a  gargle.  Unna. 

R.     Acidi  salicylici.    .    .    .   ziij 
A  Disinfectant  and  Stimulant  Mouth  Creasot'  ' 

IVash.  r  ^  \a-   ■    '    '    '    '   "^-^      . 

Ceris,  or  Adipis  .    .    .    .  aa  q.s.  to 

B .     Acidi  salicylici  .    .    .    .  3  ij  make  a  Hrm  ointment  that  will  adhere 

Spirit!  vini  rectificati  .  ^x.     M.       to  the  skin. 

Signa. — Use  as  a  gargle. 

For  Burns. 
For  Perspiration  of  Hands  and  Feet. 

B.     Acidi     salicylici.      3  parts  »•     Acidi  salicylici  .    .    .     ^j 

Magnesii   silicat  .    87  parts.     M.  ^lei    Olivae  ....     |viij    M. 

SlGNA.-Use  in  the  form  of  a  powder.       SiGNA.-Apply  as  a  lotion. 

An  Emollient  and  Antiseptic  Gargle.  Fo^  Alveolar  Pyorrhea.  ■ 

B.     Acidi  salicylici  .    .    .  ^ij  B-     Acidi  salicylici  .    .    .     3J 

Sodii  boratis  .    .    .    .  3  iij  Eucalyptol 3  vi.     M. 

Glycerini ^  iiss  SiGNA. — Apply  to  pockets  by  means  oi 

Aquae   destillatae    .    .  giij.  M.  cotton  or  a  broach. 

Antiseptic  Solution. 
Thiersch. 

B .         Acidi  salicylici 4  parts 

Acidi   borici 12  parts 

Water 1000  parts.  M. 

Useful  as  an  antiseptic  wash  and  especially  during  treatment  of  fractures  of 
maxillae. 

ACIDUM   SULPHURICUM— SULPHURIC  ACID. 
OIL    OF    VITRIOL. 

Formula. — H2SO4.     Sp.  gr.,  1.843. 

Derivation. — Sulphuric  Acid  is  obtained  by  burning  sulphur, 
mixed  with  one-eighth  of  its  weight  of  nitre,  over  a  stratum  of 
water  contained  in  a  chamber  lined  with  lead.  It  is  a  dense, 
colorless  liquid,  inodorous,  with  an  acrid  taste,  oily  consistence 
and  very  corrosive.  On  the  addition  of  water,  with  which  it 
unites  in  all  proportions,  there  is  an  evolution  of  heat.  In  the 
concentrated  form  it  is  only  used  externally  as  a  caustic.  Being 
an  acrid,  corrosive  poison,  it  causes  death  from  asphyxia.     The 


236  DENTAL  MEDICINE. 


antidote  is  magnesia  or  chalk,  or  solution  of  soap,  and  mucilagi- 
nous drinks  freely  administered. 

Medical  Properties  and  Physiological  Action. — It  is  a  powerful 
escharotic,  and  when  applied  to  living  tissue,  the  parts  first  be- 
come white,  and  subsequently  assumes  a  brownish-black  color. 
It  is  not  used  internally,  on  account  of  its  corrosive  action.  It 
is  considered  to  be  one  of  the  most  effective  caustics  in  the  bites 
of  rabid  animals. 

Diluted  Sulphuric  Acid. — Acidum  Sulphuricum  Dilutum. 

Derivation. — It  is  prepared  by  diluting  sulphuric  acid  f^vij 
with  distilled  water  f^lxxvij,  and  when  the  mixture  has  cooled  to 
60°,  by  adding  more  water  Slxxxiiiss.     Sp,  gr.,  1.094. 

Medical  Properties  and  Action. — It  is  refrigerant,  astringent  and 
tonic.  It  is  employed  as  a  refrigerant  in  fevers ;  as  an  astringent 
for  arresting  hemorrhage  and  passive  mucous  discharges,  and  as  a 
tonic  to  improve  digestion.  As  it  is  very  injurious  to  the  teeth, 
the  proper  precautions  should  be  observed,  as  in  the  case  of  all 
acids  administered  as  medicines — such  as  alkaline  gargles  used 
before  as  well  as  after  their  introduction  in  the  mouth,  and  the 
use  of  a  glass  tube  or  quill. 

Therapeutic  Uses. — Diluted  sulphuric  acid  is  employed  as  an 
internal  remedy  in  hemorrhage  from  the  lungs,  bowels  and 
uterus,  in  calculous  affections,  certain  skin  diseases,  diarrhoea, 
profuse  perspiration  of  phthisis,  in  the  advanced  stages  of  typhus 
and  typhoid  fevers,  scarlatina,  lead  poisoning,  etc.  Externally 
as  a  gargle  and  wash  to  ulcers. 

Dose. — Of  diluted  sulphuric  acid,  Ktlv  to  TTLxx,  three  times  a 
day,  in  water. 

Aromatic  Sulphuric  Acid. — Acidum  Sulphuricum  Aromati- 
cum — Elixir  of  Vitriol. 

Derivation. — Aromatic  sulphuric  acid  is  prepared  by  mixing 
sulphuric  acid  f.^iij,  with  rectified  spirit  Oij,  and  adding  cinna- 
mon .^ij,  and  ginger  .Si^^.  It  is  a  reddish-brown  liquid,  with  an 
aromatic  odor  and  a  pleasant  taste. 

Medical  Properties  and  Action. — It  is  tonic  and  astringent,  and 
is  the  most  agreeable  form  of  sulphuric  acid  for  internal  use. 

Therapeutic    Uses.- — Aromatic  sulphuric  acid  is  employed  as  a 


SULPHURIC  ACID.  237 


substitute  for  the  diluted  form  hi  debility  with  night  sweats,  loss 
of  appetite  during  convalescence  from  fevers,  hemoptysis  and 
other  hemorrhages,  and  epidemic  dysentery.  Externally  it  is  ap- 
plied to  carious  bone,  ulcers,  in  the  treatment  of  pyorrhoea  alveo- 
laris,  especially  where  there  is  necrosis  of  the  alveolar  walls, 
when  it  is  applied  on  cotton  packed  in  the  pockets ;  also  in 
chronic  alveolar  abscesses.  For  such  purposes  it  must  be  kept 
in  the  pockets,  sinuses  and  abscesses  for  several  hours  in  order  to 
insure  its  full  effects.  It  is  also  employed  locally  in  cancrum 
oris  and  gangrene  of  the  mouth,  and  largely  diluted,  it  forms  an 
efficient  astringent  mouth  wash  in  simple  stomatitis,  etc. 

Dose. — Of  aromatic  sulphuric  acid,  Hlv  to  lUxxx,  three  times 
a  day,  in  water. 

Dental  Uses  of  the  Different  Forms  of  Sulphuric  Acid. — The 
concentrated  sulphuric  acid  is  employed  as  a  caustic  in  malignant 
ulcers,  cancrum  oris,  gangrene,  etc.,  in  the  form  of  a  paste,  made 
by  mixing  it  with  powdered  sulphate  of  zinc.  The  concentrated 
sulphuric  acid  is  also  used  in  the  dental  laboratory  to  cleanse 
metal  plates,  preparatory  to  and  after  soldering,  for  which  purpose 
it  is  generally  diluted  with  one-third  of  water,  its  action  being 
greater  when  it  is  in  a  warm  state.  The  concentrated  acid  is  also 
used  in  combination  with  nitric  acid  to  reduce  hemp  paper  to 
pyroxylin,  in  the  preparation  of  the  celluloid  base. 

The  aromatic  sulphuric  acid  is  similar  in  its  action  to  the  di- 
luted form,  and  is  more  agreeable  for  use  about  the  mouth. 

It  is  a  valuable  application  in  pyorrhoea  alveolaris  (Riggs'  dis- 
ease), and  in  caries  and  necrosis  of  the  maxillarv  bones,  as  an  in- 
jection or  lotion,  as  it  stimulates  the  parts  to  healthy  action  by 
favoring  healthy  granulation.  It  may  be  applied  to  parts  about  the 
teeth,  in  cases  of  recession  of  the  gums  and  absorption  of  the 
processes,  on  a  properlv-shaped  piece  of  orange  wood.  It  is  also 
valuable  in  alveolar  abscesses  as  an  injection,  especially  in  slug- 
gish cases,  when  the  addition  of  a  few  drops  of  tincture  of  cap- 
sicum will  prove  serviceable.  It  has  the  power  of  dissolving  the 
thin,  carious  portions  of  the  bones,  such  as  the  margins  of  the 
alveolar  cavities,  and  can  be  applied  on  cotton  saturated  with  it 
and  permitted  to  remain  for  several  hours,  when  the  parts  should 


238  DENTAL  MEDICINE. 


be  perfectly  cleansed  with  warm  water.  It  is  also  employed  as 
a  gargle,  properly  diluted,  in  mercurial  inflammation  of  the  mouth 
and  other  forms  of  stomatitis,  which  do  not  yield  to  the  influence 
of  milder  astringent  washes.  It  is  also  employed  in  the  treat- 
ment of  aphthae  and  other  ulcers  of  the  mouth. 

Dr.  W.  H.  Atkinson  speaks  very  favorably  of  the  action  of 
aromatic  sulphuric  acid  upon  morbid  growths  and  ulcerating  sur- 
faces, especially  in  pockets  where  the  connective  tissue  has  been 
destroyed  and  deep  chasms  exist  along  the  line  of  teeth,  between 
the  cementum  and  alveolar  walls.  After  drying  out  such  pockets 
with  bibulous  paper,  drops  of  aromatic  sulphuric  acid,  in  full 
strength,  should  be  dropped  into  the  open  mouth  of  the  pocket  un- 
til it  stands  full,  on  a  level  with  the  surface  of  the  gum  and  teeth. 
This  is  repeated  when  the  contents  of  the  pocket  are  absorbed, 
again  and  again ;  after  which  the  mouth  is  washed  with  a  satu- 
rated solution  of  bicarbonate  of  soda  in  distilled  water.  After 
drying  the  pocket  with  bibulous  paper,  a  paste  of  tannin  and 
glycerine,  smoothly  spread  upon  several  folds  of  the  same  paper, 
is  laid  over  the  surface,  and  the  patient  directed  to  use  hydronaph- 
thol  solution  as  a  mouth  wash,  frequently  during  the  day.  The 
following  day,  the  pocket  is  washed  out  with  peroxide  of  hydro- 
gen, fifteen  volume  medicinal,  until  it  ceases  to  bubble  ;  then  re- 
peat the  application  of  the  aromatic  sulphuric  acid  in  the  same 
manner  as  first  described.  The  hydronaphthol  solution  should  be 
used  frequently,  and  also  a  bichloride  of  mercury  solution,  i.iooo, 
three  or  four  times  a  day,  until  there  is  no  longer  any  evidence 
of  pus  when  the  peroxide  is  injected.  Dr.  J.  R.  Callahan 
recommends  a  50  per  cent,  aqueous  solution  of  sulphuric  acid  for 
opening  the  canals  of  teeth  where  the  roots  are  curved  or  the 
canals  obscure,  or  obstructed  by  osseous  growths ;  it  also  acts  well 
in  the  case  of  putrescent  pulps,  as  it  destroys  animal  tissue  by 
dehydration  on  account  of  its  strong  affinity  for  water. 


SULPHUROUS   ACID.  239 


DENTAL    FORMULA. 

For  Alcrciirial  and  Ulcerative    Stoni-       IJ .      Acidi  sulphuric!    .    .  YTtxxx 

atitis.  Essence  cinnamon   .  ^ss. 

Thomas.  Aquae ^ss.        M. 

,,         A    •  1-       1   1.     •  •              w\  SiGNA. — Inject  witli  a  syringe  l  or  2 

li.      Acidi  sulphunci   .   .    .  TlL^  ...                      .^      t. 

T^          •  1      J  ■                 r"  •  minims  in  each  pocket  if  they  are 

Decocti  hordei ....  1  2  iv  ^        ^                     ' 

nr  ,,.                                r-  ,,                deep  and  sinuous,  or  carious:  re- 

Melhs •     .  1  5  ss.  M.                    ^                                           ' 

e              IT                     1  peat  every  fourth  day. 

SiGNA. — Use  as  a  gargle.  r               j                  i 

£■       -fxiw  J    .7       TTj  X  nr  P'^^  Diarrhaa  Durim'  DentiHon. 

ror  Apht/icE  and  other  Ulcers  of  AIu-  •^ 

cotis  Membrane  and  Gums.  If  t'^^  stools  are  serous  and  alkaline, 

R.      Acidi  sulphurici  .    .    .  f^^ss.  Dr.  James  W.  White. 

Mellis f^j.       M.  R.      Acidi  sulph.  aroniat.  gtt.  viij 

Signa. — To  be  applied  with  a  cam-  Spt.  vini  galiici  .    .    .  f^ij 

el-hair  brush.  Syr.  acacia;      .... 

For  Alveolar  Pyorrhcea.  Aquae  menth.  pip.  aaf  3  ss.      M. 

Dr.  A.  W.  HarLan.  Signa.-A     teaspoonful     every     2 

hours  in  a  little  water. 

For    Carious    Bone,  Riggs"  Disease,  etc. 

Ji.      Acidi    sulphurici  aromat '^3'" 

Tinctura    capsici gtt.x 

Aqufe ^S'''  M. 

SlGNA. — To  be  used  as  an  injection  or  lotion. 

ACIDUM  SULPHUROSUM— SULPHUROUS  ACII). 

Formula. — HoSOg. 

Derivation. — Sulphurous  Acid  is  made  by  dissolving  sulphur- 
ous anhydride  (SO^)  in  water.  The  anhyride  is  made  by  burning 
sulphur.  It  is  a  colorless  liquid,  having  the  suffocating  odor  of 
burning  sulphur,  and  a  sour,  astringent  taste. 

Medical  Properties  and  Action. — It  is  a  deodorizer  and  disinfect- 
ant, and  destructive  to  micro-organisms,  such  as  bacteria,  fungi, 
etc. 

Owing  to  its  affinity  for  oxygen  it  acts  upon  organic  matter 
with  great  energy. 

Therapeutic  Uses. — The  diluted  acid  is  locally  applied  to  ulcers 
of  the  tonsils  in  diphtheria,  syphilitic  and  tuberculous  laryngitis, 
chilblains,  parasitic  skin  diseases,  ill-conditioned  sloughing  or 
gangrenous  wounds;  also  used  in  pyrosis,  indigestion,  etc. 

Also,  in  the  form  of  inhalations  of  the  sulphurous-acid  gas,  in 


240  DENTAL  MEDICINE. 


cases  of  chronic  bronchitis,  etc.  In  the  form  of  spray,  it  is  used 
as  a  local  application  in  diseases  of  air  passages. 

Dose. — Of  sulphurous  acid,  TTLv  to  5j,  properly  diluted. 

Dental  Uses. — Dilute  sulphurous  acid  is  efficacious  in  mercurial 
stomatitis,  aphthae,  and  mucous  patches,  gangrene  of  the  mouth, 
cancrum  oris,  ulcers  of  mucous  membrane,  and  sloughing 
wounds.     It  is  an  efficient  and  convenient  disinfectant. 

For  Chilblains.  For  Destroying  Parasites  in  Skin  Diseases. 

Bartholow.  Startin. 

R.     Acidi  sulphurosi    .    .  ^iij  R.     Acidi  sulpburosi,dil.  .  ^^ss 

Glycerini    ....  3J  Sodii  hyposulphitis    .  ^iij 

Aquae 5  iss.  M.  Aqure,  q.  s.  ad.    ...  5  xvj.     M. 

SiGNA. — Apply  as  a  lotion.  SiGNA. — Apply  as  a  lotion. 

For  Aphthce. 

Dr.    POTIER. 

R .     Acidi  sulphuiosi ^^5 ij 

Aquse,  q.  s.  ad ^  ij.     M. 

SlGNA. — Mouth  wash,  or  may  be  used  as  a  spray. 

ACIDUM  TANNICUM— TANNIC  ACID. 
TANNIN. 

/or/nw/tf.— C27H22O17. 

Derivation. — Tannic  Acid  is  obtained  by  exposing  powdered 
galls  to  a  damp  atmosphere  for  several  days,  when  sufficient 
ether  is  added  to  form  a  soft  paste,  which  is  allowed  to  stand  for 
twenty-four  hours.  It  is  then  subjected  to  pressure  as  quickly  as 
possible,  and  the  mass  again  treated  with  ether,  to  which  iV  of  its 
bulk  of  water  has  been  added ;  this  is  allowed  to  stand  as  before, 
and  is  again  subjected  to  pressure.  The  expressed  liquids  are 
now  combined  and  allowed  to  evaporate  spontaneously  ;  then,  by 
the  aid  of  a  little  heat,  brought  to  a  syrupy  consistence,  when  it 
is  dried  on  plates  in  a  hot  air  chamber,  at  a  temperature  not  ex- 
ceeding 212°  F.  Pure  tannic  acid  is  solid,  uncrystallizable, 
either  white  or  slightly  yellowish,  inodorous,  astringent  to  the 
taste,  but  without  bitterness,  and  with  an  acid  reaction.  It  is 
obtained  in  the  form  of  vesicular  masses,  or  thin,  glistening 
scales,  or  in  the  shape  of  fine  threads  of  a  pseudo-crystalline  ap- 


TANNIC   ACID.  241 


pearance.     Tannic  acid  exists  also  in  rhatany,  catechu,  and  other 
vegetable  astringents,  as  it  is  their  chief  principle. 

Medical  Properties  and  Jction. — Tannic  Acid  is  considered  to 
be  the  most  active  of  all  vegetable  astringents  and  styptics,  and 
especially  powerful  on  albumen,  gelatin  and  fibrin.  It  is  very 
soluble  in  water,  and  less  so  in  alcohol  and  ether.  Taken  in- 
ternally it  produces  no  nausea,  is  perfectly  safe,  and  its  use  may 
be  continued  for  a  long  time  without  any  ill  effects.  It  may 
also  be  administered  before  and  after  meals,  at  all  times,  and  be 
combined  with  many  other  remedies,  such  as  iron,  cod-liver  oil, 
bitters,  etc.  Like  gallic  acid,  it  is  capable  of  taking  oxygen  even 
from  the  blood  globules,  when  in  contact  with  alkalies. 

It  constringes  the  tissues,  temporarily  decreasing  their  vascular- 
ity, and  causing  contraction  of  their  blood  vessels.  It  arrests 
secretion  and  condenses  relaxed  and  feeble  tissues.  When  mixed 
with  blood,  it  forms  a  clot  rapidly  on  account  of  coagulation  of 
the  albumen. 

Tannic  acid  is  converted  into  gallic  acid  in  the  blood,  by 
absorbing  oxvgen  from  the  red  corpuscles ;  this  absorption  does 
not  occur  in  the  stomach. 

Tannic  acid  unites  with  albumen,  fibrin  and  gelatin,  forming 
insoluble  tannates,  thus  preserving  the  parts  beneath  from  the  in- 
fluence of  irritating  agents  until  resolution  occurs. 

Its  solution  reddens  litmus  paper,  and  it  is  decomposed  and 
entirely  dissipated  when  thrown  upon  red-hot  iron. 

Listerine  is  one  of  the  best  solvents  for  tannic  acid.  One 
ounce  of  listerine  will  dissolve  half  an  ounce  of  tannic  acid. 

Therapeutic  Uses. — Internally  it  is  administered  in  hemorrhages 
of  the  lungs,  stomach,  kidnevs  or  uterus,  chronic  bronchial  ca- 
tarrh, phthisis,  after  softening  has  taken  place,  intermittent 
fever,  whooping-cough,  chronic  diarrhoea,  diseases  of  the  genito- 
urinary organs,  dyspepsia,  diphtheria,  nervous  diseases,  etc.  Ex- 
ternally it  is  applied  to  hemorrhages  and  profuse  secretions, 
mercurial  salivation,  diseases  of  the  eye,  nasal  polypus,  gonor- 
rhoea and  gleet,  bed-sores,  relaxation  of  uvula,  skin  diseases, 
ulcers,  etc. 

Dose. — Of  tannic  acid,  gr.  j  to  3j,  in  pill. 
16 


242  DENTAL  MEDICINE. 


Dental  Uses. — In  dental  practice  tannic  acid  is  a  valuable  agent 
for  local  use  in  the  treatment  of  such  diseases  as  mercurial  stoma- 
titis, ulceration  of  the  gums  and  mucous  membrane  of  the  mouth, 
hypertrophy  of  the  gums,  hemorrhage  following  the  extraction  of 
teeth  and  wounds  of  mucous  membrane,  fungous  growth  of  pulp, 
sensitive  dentine,  sponginess  of  the  gums,  for  the  temporary  re- 
lief of  odontalgia,  disease  of  the  antrum.  In  mercurial  salivation 
tannic  acid,  in  the  form  of  powder,  moistened  with  water,  will 
render  the  spongy  gums  firmer  and  more  comfortable,  causing 
contraction  of  the  vessels  and  checking  a  tendency  to  absorption 
and  the  consequent  loosening  of  the  teeth.  A  strong  solution  of 
tannin  in  alcohol  is  beneficial  in  obtunding  the  sensitiveness  of 
dentine,  or  the  tannin  may  be  in  the  form  of  a  powder,  com- 
bined with  morphine  and  creasote.  Tannic  acid,  in  the  form  of 
a  paste  or  ointment,  made  by  rubbing  two  scruples  of  tannin  with 
twenty  drops  of  glycerine,  and  then  with  an  ounce  of  lard,  makes 
a  good  astringent  application.  A  gargle  composed  of  tannic  acid 
and  glycerine  is  a  useful  application  for  abrasions  caused  by  arti- 
ficial teeth  and  other  irritants.  A  preparation  known  as  Elixir 
of  Vitriol  and  Tannin^  saturated  solution,  is  a  powerful  astringent 
and  hemostatic  when  applied  to  bleeding  surfaces,  fungous 
growths,  etc. 

An  English  preparation  known  as  Styptic  Colloid^  is  a  saturated 
solution  of  tannin  and  gun  cotton,  and  is  highly  recommended 
for  its  styptic  and  deodorizing  properties,  as  it  solidifies  blood  and 
albumen  by  mere  contact,  and  can  be  applied  directly  by  means 
of  a  camel's-hair  brush,  or,  mixed  with  an  equal  quantity  of  ether, 
in  the  form  of  spray.  No  irritation  follows  its  use,  and  for 
hemorrhage  from  the  extraction  of  teeth,  or,  in  the  treatment  of 
necrosed  or  carious  maxillary  bones,  it  is  very  efficient.  Cold  or 
warm  water  will  not  dissolve  it ;  but  an  ether  and  alcohol  solu- 
tion may  be  used  to  remove  the  dressing. 

Tannic  acid,  as  an  internal  remedy,  has  also  been  successfully 
administered  for  checking  hemorrhage  after  tooth-extraction. 
Dr.  W.  L.  Roberts  says :  Tannic  acid,  administered  internally, 
in  proper  doses,  will  stop,  I  believe,  any  case  of  such  hemorrhage 
in  from  thirty  minutes  to  one  and  one-half  hour's  time.     He  rec- 


TANNIC   ACID. 


243 


onimends  three  grains  of  tannic  acid  in  one-third  glass  of  water, 
giving  as  a  dose  two  teaspoonfuls  of  the  solution  every  five  min- 
utes until  three  doses  are  taken  ;  then  two  teaspoonfuls  every 
fifteen  minutes  if  required.  Dr.  Roberts  further  says,  that  such 
treatment  has  never  failed  him. 

A  styptic  and  antiseptic  cotton  can  be  prepared  by  saturating 
purified  cotton  with  tannic  acid,  5  parts  j  carbolic  acid,  4  parts; 
alcohol,  50  parts.  The  cotton  should  be  dried  and  preserved  air- 
tight. 

Glycerite  of  tannic  acid — Glyceritum  Acidi  Tannici^  for  exter- 
nal use,  is  made  of  tannin,  Sij.;  glycerine,  5viij.  Useful  for 
inflamed  and  relaxed  conditions  of  the  uvula  and  fauces,  applied 
by  means  of  a  camel's-hair  brush. 

Ointment  of  tannic  acid —  Unguentum  Acidi  Tannici^  is  made 
of  tannin,  5j ;  lard,  .5j.     Useful  for  a  local  application  to  ulcers. 


DENTAL    FORMULiE. 


H- 


R 


For  an  Astringent  Dentifrice. 
Acidi  tannici  .    .    .    .  gr.  xxx 
Cretae  preparatae     .    .  ^  ij 
Pulveris  ossis  sepise    .  3  ij 
Olei  caryophylli  .    .    .  gtt.  iij.  M. 

For  Inflamed  Mucous  JMeinbrane, 
Abrasions,  Ulcers  and  Sensitive 
Dentine. 
.     Acidi  tannici  .    .    .    .  jij 
Tincturae  arnicae    .    .  ^i] 
Tincture  myrrhjE  .    .  J  M. 

SiGNA. — To  be  used  as  a  lotion. 

For  same  as  above. 
Ji.    Acidi  tannici   .    .    .    .  gj   to   ^ij 
Spiiiti  rectificati  .    .    .  ^j 
Aquae  destillalae  .    .    .  J  x.        M, 
SlGNA. — To  be  used  as  a  gargle. 

For  Inflamed  and  Ulcerated  Mucous 
Membrane. 
B.     Acidi  tannici   .    .    .    .  jss 
Spirit!  vini  rectificati  .  ^ss 
Aquae  camphorae     .    .  f  3  v.      M. 
SiGNA. — To  be  used  as  a  gargle. 


For  htflamed  and  Ulcerated  Gums. 

li .     Acidi  tannici  .    .    .    .  3  iv 

Glycerini ^ij.       M. 

SiGNA. — To   be   used   as  a  gargle  or 
mouth  wash. 


For  same  as  above. 


R. 


3iJ 

giv 

gr.xx 

^iv 

f  ^  viij.  M. 


Acidi  tannici   . 

Tinct.  iodinii  . 

Potassii  iodidi 

Tinct.  myrrhae 

Aquae  rosae  .    . 
SiGNA. — A  dessert-spoonful  in  a  wine- 
glass of  water  as  a  mouth  wash  or 
gargle. 

For  Inflamed  Mucous   Membrane   of 
Mouth. 

R.     Acidi  tannici  .    .    .    .  ^ij 
Pulveris  aluminis    .    .  gr.xxx 
Aquae  destillatae  .    .    .  ^v.        M. 

SiGNA. — To  be  used  as  a  gargle. 


244 


DENTAL  MEDICINE. 


For   Sensitiveness  folloiving    the    Re- 
moval of  Salivary   Calculus. 
Coleman. 
R.     Acidi  tannici    .    .    .    -     ^ss 

Eau  de  Cologne  .    .    .  f^iv.     M_ 

SiGNA. — Add   lo  or  12  gtts.  of  above 

solution    to   a   teaspoon  ful    of   tepid 

water,  and  use  as  a  gargle  3  or  4 

times  a  day. 

For  Loose  Teeth  and  Spongy  Gums. 
R.     Acidi  tannici   .    .    .    .  ^jss 
Potassii  iodidi     .    .    .  gr.xii 

Tinct.  iodi ^j 

Tinct.  myrrhse    .    .    .  ^j 

Aquae  rosse ^  vj.      M. 

Dissolve  the  tannic  acid  and  iodide 
of  potassium  in  the  rose  water  and  add 
the  tinctures  and  strain. 
SiGNA. — A  teaspoonful  in  a  wine-glass 
of  warm  water,  used  every  morning 
as  a  mouth  wash. 
For  an  Astringent  Mouth  Wash  in  In- 
Jlamed  and  Ulcerated  Conditions  of 
Gum  and  Mucous  Membrane. 
B ,     Acidi  tannici  ....  gr.x  to  xv 
Tincturae  pyrethri  .    .  3  iij 

Aquae  rosae ^  vj.      M. 

SiGNA. — To  be  used  as  a  gargle. 

For  Ulcerations  and  Abrasions. 
R.     Acidi  tannici        ...  gr.xv 

Glycerini f^j.       M. 

SiGNA. — To  be  used  as  a  lotion. 

For  Injlamed  Mucous   Membrane  of 
Mouth. 

R.     Acidi  tannici  .    .    .    .  ^ss 
Sodii  boratis    .    .    .    .  ^iij 

Glycerini ^  ij 

Aquae  destillatas  .    .    .  ^  iv.       M. 

SiGNA. — Use  as  a  gargle. 


For  Inflamed  Mucous  Alembrane  of 
Mouth  and  Fauces. 

U.     Acidi  tannici   .    . 

Tinctura  myrrhae 

Pulv.  acaciae    .    . 

Glycerini     .    .     . 

Aq.   destil.  q.s.ad.    .    .  x  vj.       M. 
SiGNA. — Use  as  a  gargle 


3J 
3 ''J 

3^j- 


For  Odontalgia. 
Druitt. 
IJ.     Acidi  tannici   ....  gr.xx 
Gun  mastich    ....  gr.x 
Spt.  aether  sulph    .    .  f^ss.     M. 
SlGNA. — To  be  applied  to  carious  cav- 
ity, on  a  pellet  of  cotton. 

For  Alveolar  Hemorrhage. 
R.     Acidi  tannici   ....  gr.xl 
Liq.     plumb,    subacet. 

dilut f.l'ss 

Vin.  opii f,?ss.     M. 

SiGNA. — Apply  on  cotton  or  lint,  or  as 
an  injection. 

For  Chronic  Ulcers  and  Abscesses. 
Berel. 
U .     Acidi  tannici  ....  gr.xxxij 

Aquae  destillatae  .    .    .  f^viij.  M. 
SiGNA. — To  be  used  as  a  lotion. 

Astringent  and  Antiseptic  Gargle. 

U .     Tannin 5  grammes. 

Tincture  iodine  .    .    . 

Tincture  myrrh  .  ail  2^  grammes. 

Iodide  of  potassium   .  i  gramme. 

Rose  Water   .    .    .  180  grammes. 

M. 

SiGNA. — A    teaspoonful   in  a  glass  of 

water. 


ACIDUM  TARTARICUM— TARTARIC  ACID. 

Formula. — HjC^H^Og. 

Derivation. — Tartaric   Acid   is  obtained   from  "  tartar  "  (a  pe- 
culiar substance  which  concentrates  on  the  inside  of  wine  casks. 


ACONITE.  245 

being  deposited  during  the  process  of  fermentation),  or  from 
crude  cream  of  tartar. 

It  is  in  the  form  of  white  or  colorless  crystals,  irregular,  six- 
sided  prisms,  and  is  soluble  in  water  and  alcohol,  and  wholly  dis- 
sipated by  heat. 

Medical  Properties  and  Action. — It  is  refrigerant,  and  dissolved 
in  water  and  sweetened,  is  a  good  substitute  for  lemonade. 

In  large  doses  it  is  an  irritant  poison,  and  when  its  internal  use 
is  followed  by  a  red  and  dry  tongue,  it  should  be  discontinued. 
It  is  often  administered  in  the  form  of  effervescing  powders. 

Therapeutic  Uses. — Internally  it  is  employed  as  a  refrigerant  in 
inflammatory  and  febrile  diseases,  irritability  of  the  stomach, 
nausea  and  vomiting,  dyspepsia,  and  diseases  attended  with  copious 
secretion  of  mucus,  dysentery,  etc.,  etc. 

Dose. — Of  tartaric  acid,  gr.  x  to  gr.  xx,  dissolved  in  water  and 
sweetened. 

Dental  Uses. — In  combination  with  an  equal  quantity  of 
chloride  of  lime,  it  is  employed  for  bleaching  discolored  teeth. 

ACOXITUM— ACONITE. 
WOLFSBANE,  MONKSHOOD. 

Source. — Aconite  is  obtained  from  the  dried,  tuberous  root  of 
Jconitum  Napellus.,  a  perennial  plant  abounding  in  the  mountains 
of  Europe  and  Asia.  The  leaves  and  root  are  both  used,  but  the 
latter  is  the  most  powerful.  The  alkaloid  Aconitia  or  Aconitine^ 
a  sedative  poison,  is  obtained  from  the  root,  and  is  externally  em- 
ployed for  neuralgic  affections,  producing  a  sensation  of  heat  and 
pricking,  succeeded  by  a  feeling  of  numbness  and  constriction  in 
the  part  on  which  it  is  rubbed  ;  and  very  satisfactory  results  have 
been  obtained  from  the  internal  administration  of  Duquesnel's 
Aconitia,  in  neuralgia  of  the  fifth  pair  of  nerves.  Another  prin- 
ciple of  aconite,  suggested  by  Duquesnel,  is  known  as  Napelline^ 
which  is  less  powerful  than  aconitia,  but  possesses  important 
hypnotic  properties,  and  is  substituted  for  opium  and  chloral,  es- 
pecially in  cases  of  wakefulness  and  mental  excitement  during 
neuralgic  attacks. 

Medical  Properties  and  Physiological  Action. — Aconite  is  a  pow- 


246  DENTAL  MEDICINE. 


erful  sedative  to  the  nervous  system,  and  reduces  the  force  of  the 
circulation.  In  large  doses  it  is  an  active  poison,  lessening  the 
heart's  action,  affecting  its  ganglia  and  muscle,  and  paralyzing 
the  muscles  of  respiration.  In  moderate  doses  it  produces  warmth 
in  the  stomach,  general  warmth  of  the  body,  and  sometimes 
nausea,  numbness  and  tingling  in  the  limbs  and  fingers,  muscular 
weakness,  diminished  force  and  frequency  of  the  pulse  and  dimin- 
ished respiration.  It  proves  fatal,  in  poisonous  doses,  by  its  pow- 
erful sedative  impression  on  the  nervous  system,  by  suspension 
of  the  respiratory  function  and  by  syncope. 

Therapeutic  Uses. — Aconite,  in  the  form  of  an  extract  prepared 
from  the  leaves,  and  a  tincture  prepared  from  the  root,  is  admin- 
istered in  all  inflammatory  and  febrile  affections,  acute  rheuma- 
tism, neuralgia,  especially  in  chronic  cases  of  neuralgia,  where 
all  the  signs  of  active  disease  are  absent,  or  have  been  relieved 
by  other  remedies ;  tetanus,  sciatica,  diseases  of  the  heart,  ery- 
sipelas, amenorrhoea,  tonsilitis,  acute  congestion  of  liver,  peri- 
tonitis, eruptive  fevers,  etc.,  etc.  It  is  contraindicated  in  inflam- 
matory conditions  of  the  gastro-intestinal  mucous  membrane.  It 
is  locally  applied  to  painful  sprains  and  bruises,  and  chronic 
arthritic  swellings. 

Dose. — Of  the  tincture  of  aconite — tinctura  aconitt — gtt.  j  to 
gtt.  v;  of  the  extract  of  aconite — exU-actum  aconit'i — gr.  j  to  gr. 
ij.  The  tincture  of  the  root  is  composed  of  twelve  troy-ounces 
to  alcohol  Oij.     Dose  of  aconitia,  gr.  jItt. 

Dental  Uses. — Aconite,  in  the  form  of  the  tincture,  is  a  val- 
uable agent  in  dental  practice.  When  locally  applied,  it  checks 
inflammation  in  its  early  stages,  by  paralyzing  the  nerves  of  the 
part  and  lessening  the  excitement  to  the  local  afflux  of  blood, 
favoring  resolution  and  limiting  the  extent  of  an  abscess  where 
pus  is  already  formed.  Combined  with  an  equal  part  of  the 
tincture  of  iodine,  it  is  a  valuable  application  in  the  incipient 
stages  of  periodontitis,  as  it  relieves  the  inflammation  by  retarding 
the  circulation  and  stimulating  lymphatic  action.  For  such  pur- 
poses the  gum  or  root  of  the  affected  tooth  should  be  painted 
with  this  combination  until  it  assumes  a  dark  brown  color,  taking 
the  precaution  to  first   remove  all  moisture  from  the  surface  to 


ACONITE.  247 

which  it  is  to  be  applied,  and,  after  its  application,  protecting  the 
adjoining  parts,  such  as  the  lips  or  cheeks,  until  the  remedy  is 
absorbed.  A  drop  or  two  of  the  tincture,  introduced  into  the 
cavity  of  an  aching  tooth,  will  relieve  odontalgia  ;  and  the  same 
quantity  will  subdue  the  pain  which  follows  the  extraction  of  a 
tooth,  especially  when  the  cause  has  been  the  inflammation  of 
the  peridental  membrane.  Tincture  of  aconite  is  also  serviceable 
in  the  conservative  treatment  of  irritated  or  inflamed  pulps  of 
teeth.  Combined  with  an  equal  quantity  of  chloroform,  it  is  ap- 
plied as  a  local  anaesthetic  for  the  extraction  of  teeth.  For  the 
same  purpose  it  is  combined  with  chloral,  pyrethrum,  morphia, 
etc.  (See  Dental  Formulae.)  It  is  also  a  useful  dressing  for  the 
pulp  canals  of  teeth,  preventing  the  formation  of  inflammatory 
products.  The  alkaloid,  aconitia^  is  a  useful  remedy  in  neuralgia 
of  the  fifth  pair  of  nerves.  (See  Dental  Formulas.)  Care  is 
necessary  in  the  application  of  the  tincture  of  aconite  to  large 
surfaces,  or  where  the  skin  is  abraded,  as  dangerous  constitutional 
effects  may  result.  Fifteen  drops  of  the  tincture,  taken  inter- 
nally, have  caused  death.  The  symptoms  of  poisoning  by  aco- 
nite are  as  follows  :  Overpowering  sense  of  fatigue  in  the  lower 
extremities,  great  muscular  weakness,  dimness  of  vision,  with 
dilated  pupils ;  great  dyspnea,  the  respiration  being  short  and 
labored  ;  the  pulse  at  first  slow  and  small,  and  afterward  imper- 
ceptible ;  surface  of  body,  tongue  and  breath  cold ;  a  profuse 
perspiration ;  muscles  of  respiration  paralyzed  ;  ceasing  of  the 
heart's  action.  The  antidotes  are  emetics  and  stimulants — heat, 
brandy  and  ammonia;   patient  kept  flat  on  back. 

DENTAL 
For  Neuralgia. 
R  .     Pulveris  radicis  aconiti     ^  x 

Camphorae ^ss 

Spiriti  rectificati  .  .  .  q.  s. 
Moisten  the  aconite  with  some  of  the 
alcohol  and  macerate  in  a  close  vessel 
for  3  days,  then  percolate  slowly  into  a 
receiver  containing  the  camphor  until 
product  measures  half  a  pint. 
SiGNA.-Apply  with  a  camel's-hair  brush. 


)r: 

MUL^. 

For  Odontalgia. 

B 

.     Tinctur£E  aconiti, 

Chloroformi  .    .    . 

.  aa  f^iij 

Tinct.  capsici    .    . 

•f.5J 

Tinct.  pyrethri., 

01.  caryophylli  .   . 

.  aa  f  5  ss 

Gum  camph.  .    .    . 

.  gss.       M. 

SiGNA. — To   be  applied 

on  a  pellet  of 

cotton. 

248 


DENTAL  MEDICINE. 


A  Local  Anast/ielic  for  the  Exlraclion 
of  Teeth. 


u. 


gr.  X 
gr.  iv 

gr.  iv.  M. 


Tinctuiae  aconiti  . 

Pyrethri    .... 

Veratrinae     . 

Morphinae  sulphas 

Spiriti  rectificati  . 

Chloral  hydratis   . 
Let  it  stand  4  days  and  then  filter. 
SiGNA. — Apply  to  the  gum  over  root  of 
tooth  to  be  removed  for  60  seconds, 
by  means  of  an  applicator. 

For  a  Local  AncBsthetic  for  Extraction 
of  Teeth. 

R.     Tinctura  aconiti    .    .    .    f^j 

Menthol gr-  x 

Chloroform! f^j.     M. 

SiGNA. — Apply   freely   to   gum   about 
tooth  for  several  minutes. 


For  Neuralgia  and  Rheumatic  Pains, 
Bruises,  etc. 

R .     Tincturse  aconiti, 
Chloroformi  venalis, 
Spiriti  ammoniae  .    .  aa  f^ij 
Oleo  ricini    ....  3  i 
Linimenti  saponis    .  f^j  M. 

SiGNA. — To  be  rubbed  on  the  affected 
part. 

For    Neuralgia     of    Fifth    Pair    of 
Nerves. 

(For  Internal  Use.) 

B  .     Aconitum gr.  -^^ 

Glycerini, 

Alcohol aa  3J 

Aquse  menthae  pip.  .    ?  ij.  M. 

Dose. — A  teaspoonful. 


For  A'euralgia. 
IJ.     Lmimenti  aconiti, 

Lin.  belladonme  .    .  aa  Jvij 
Chloroformi  .    .    .    .  ^  ij.  M. 

SiGNA. — Apply  on  lint,  to  the  part  af- 
fected, and  cover  with  a  fine  piece 
of  sponge  saturated  with  warm 
water. 

For  Trige»iinal  A'euralgia. 
R .     Aconitine  Crystalisee 

(Duquesnel's)  .    .    .  gr.  ^j^ 

Glycerini, 

Alcohol aa  3J 

Aquae  menthae  pip.  .  ^  ij.  M. 

Dose. — A  teaspoonful,  slowly  and  cau- 
tiously increased  by  adding  to  the 
solution  ^  of  a  grain  of  the  aconite 
instead  of  y^^. 

For  Periodontitis. 
R .     Tincturae  iodi, 

Tincturae  aconiti  .    .  aa  ^ss.     M. 
SiGNA. — Apply  to  gum  over  root  of  af- 
fected tooth  with  a  canter s-hair  brush. 

To  Abort  an  Abscess, 
Dr.  Geo.  Watt. 
R .     Ext.  aconiti,  fl. 

Ext.  belladonnae,  fl. 
Ext.  opii.,  fl  aa  equal  parts.       M. 
SiGNA. — Apply  with  brush  as  needed 
to  ease  pain,  also  give  fluid  extract 
of  phytolaccse  internally. 

For   Odontalgia,   Internal  Treatment. 

Dr.  Dunogier. 
R .     Aconitum  (crystallized)  %  milligr. 

Gelsemine i  milligr. 

Valerianate  of  quinine  5  centigr. 
For  one  pill. 
M.  S. — One  to  three  pills  to  an  adult 
in  the  24.  hours. 


ETHER.  249 

.^iTHER-ETHER. 
iETHER    SULPHURICUS — SULPHURIC    ETHER. 

Formula. — C^HjyO,  or  (02^15)20.  Sp.  gr. — Of  pure  ether, 
0.713;  of  stronger  ether,  0.728;  of  ordinary  officinal  ether, 
0.750. 

Derivation. — Sulphuric  Ether  is  obtained  by  the  distillation  of 
alcohol  and  sulphuric  acid,  and  is  rectified  by  re-distillation  with 
solution  of  potassa.  The  form  of  sulphuric  ether  employed  for 
inhalation  is  still  further  purified  by  agitation  with  water,  and  it 
is  freed  from  this  and  from  an  excess  of  alcohol  and  deleterious 
acid  substances  by  the  action  of  chloride  of  lime  and  freshly 
calcined  lime,  when  it  is  known  as  stronger  ether — /Ether 
Fortior.  Pure  ether  has  a  Sp.  gr.,  0.713,  and  is  practically  free 
from  alcohol  and  water.  Sulphuric  ether  is  a  colorless,  limpid, 
volatile  and  inflammable  fluid,  with  a  sweet,  penetrating  odor 
and  a  hot,  pungent  taste ;  on  account  of  its  great  volatility,  it 
should  be  kept  securely  in  ground-glass-stoppered  bottles.  It 
should  never  be  held  near  a  fire  or  light.  It  usually  reddens 
litmus  paper  slightly ;  when  it  does  so  strongly,  the  ether  is  im- 
pure. The  impurities,  besides  acids  and  fixed  substances,  are 
heavy  oil  of  wine,  an  excess  of  alcohol  and  water.  Acids  be- 
ing detected  by  litmus  paper,  may  be  removed  by  agitation  with 
potassa ;  fixed  substances  may  be  removed  by  evaporating  the 
ether.  Some  alcohol  is  always  found  in  ether,  and  it  is  only 
when  it  is  present  in  too  great  a  quantity  that  the  density  of  the 
ether  is  rendered  too  high.  The  quantity  of  alcohol  any  prep- 
aration of  ether  may  contain,  can  be  determined  by  agitating  it 
in  a  minim  measure  with  half  its  volume  of  a  concentrated 
solution  of  chloride  of  calcium.  This  will  remove  the  alcohol, 
and  the  reduction  of  the  volume  of  ether  when  it  rises  to  the 
surface  will  indicate  the  amount  of  alcohol  which  has  been  pres- 
ent. Heavy  oil  of  wine  can  be  detected  by  the  ether  becoming 
milky  when  mixed  with  water.  Ether  boils  at  95°  P\,  and  a 
cold  of  166°  below  zero  will  not  freeze  it.  When  kept  too 
long  it  undergoes  decomposition,  and  is  converted  in  part  into 
acetic  acid. 

It  evaporates  so  readily  and  completely  in  the  air  as  to  cause  a 


250  DENTAL  MEDICINE. 

great  degree  of  cold  ;  hence  it  has  been  employed  in  the  form  of 
spray,  as  a  local  anaesthetic.  It  combines  with  alcohol  and 
chloroform  in  all  proportions,  and  dissolves  in  ten  times  its 
volume  of  water. 

Medical  Properties  and  Physiological  Action. — Ether  is  a  diffusible 
stimulant,  antispasmodic,  anodyne  and  anaesthetic.  Its  action  on 
the  animal  organism  is  rapid  and  powerful,  but  temporary,  and, 
except  for  its  rapidity,  is  similar  to  that  of  alcohol.  When  ap- 
plied to  the  skin  it  produces  intense  cold  by  its  evaporation,  and 
when  applied  in  the  form  of  spray  it  benumbs  or  locally  freezes 
a  part. 

Both  the  liquid  and  vapor  act  as  an  irritant  to  mucous  mem- 
branes, and  its  vapor  when  first  inhaled  causes  great  irritation  of 
the  fauces  and  respiratory  tract,  often  causing  a  temporary  arrest 
of  respiration,  the  face  becoming  suffused  and  red  and  the  con- 
junctiva injected,  such  conditions  causing  restlessness  and  strug- 
gling; but  a  quiet  stage  soon  follows  the  primary  stage.  During 
this  second  stage,  the  breathing  is  usually  full  and  deep,  and  the 
pulse  rapid  and  strong,  the  ocular  reflfexes  at  the  beginning  being 
intact.  The  second  stage  may  also  be  one  of  struggling,  during 
which  the  patient  may  become  uncontrollable  except  by  great  force, 
but  if  the  inhalation  be  pushed  a  third  stage  of  complete  anaesthesia 
is  soon  attained,  when  any  surgical  operation  may  be  performed. 
The  inhalation  should  not  be  carried  to  complete  flaccidity 
of  muscular  contraction  as  the   respiration    may  be  obstructed. 

Sulphuric  ether  first  acts  upon  the  brain,  then  upon  the  sensory 
and  motor  tracts  of  the  spinal  cord,  then  on  the  sensory  and 
motor  tracts  of  the  medulla  oblongata,  and,  if  given  to  excess 
it  causes  death  from  respiratory  failure.  It  produces  no  effect 
upon  the  nerve  trunks  unless  it  is  directly  applied  to  them.  It 
does  not  act  by  any  destructive  influence  on  the  blood,  but  simply 
suspends  for  a  time  the  vital  functions  of  the  part  which  it  effects. 
It  is  one  of  the  most  diffusible  and  rapid  cardiac  stimulants,  in- 
creasing the  pulse  rate  and  force,  and  stimulating  the  heart  and 
the  arterial  pressure  by  accelerating  the  activity  of  vaso-motor 
centres.  In  excessive  doses  it  is  a  depressant  of  the  heart,  and 
decreases  the  haemoglobin  and  the  number  of  the  red  corpuscles, 


ETHER.  251 

especially  in  the  anaemic.  It  acts  as  a  powerful  stimulant  on 
the  respiratory  centre,  but  in  excessive  doses  it  paralyzes  this 
portion  of  the  system.  It  lowers  the  bodily  temperature  by  de- 
pressing the  nervous  system,  and  by  its  evaporation.  It  is  elim- 
inated by  the  lungs  and  kidneys.  It  is  administered  internally  in 
the  form  of  ether  or  of  Hoffmann's  Anodyne,  compound  spirit 
of  ether — Spiritus  Etheris  Compositus  (composed  of  ether,  Oss, 
ethereal  oil,  f  5vj,  and  alcohol,  Oj),  also,  in  the  form  of  spirit  of 
nitrous  ether,  Spiritus  Etheris  Nitrosi^  and  known  as  sweet  spirit 
of  nitre  (a  solution  of  nitrous  ether  in  alcohol).  Ether  is  in- 
ternally given  in  ice-cold  water  or  capsule. 

When  ether  is  taken  into  the  stomach,  it  causes  a  cooling 
sensation,  after  the  subsidence  of  the  burning,  which  is  quickly 
diffused  over  the  body;  increased  action  of  the  heart,  flushing 
of  face  and  warmth  of  surface  follow  in  a  icw  minutes;  the 
senses  are  quickly  excited  ;  the  mind  becomes  more  active,  and 
the  phenomena  of  alcoholic  intoxication  result,  which  soon  pass 
away,  leaving  a  feeling  of  calmness  and  sleep. 

Therapeutic  Uses. — Ether  is  employed  internally  as  an  anti- 
spasmodic and  anodyne,  for  angina  pectoris,  hysteria,  asthma, 
flatulence,  cramp  of  stomach  and  bowels,  syncope,  epilepsy, 
hiccough,  nervous  or  hysterical  headache.  Hoffmann's  Anodyne 
possesses  the  antispasmodic  and  stimulating  effects  of  ether,  and 
the  anodyne  effects  of  ethereal  oil,  or  oil  of  wine,  and  is  also 
carminative.  Ether  vapor  should  not  be  administered  in  bron- 
chitis or  acute  kidney  disease  on  account  of  its  irritant  effects, 
nor  in  aneurism,  peritonitis  or  gastritis. 

The  Spirit  of  Nitrous  Ether  is  antispasmodic,  diaphoretic,  and 
diuretic,  and  is  employed  in  febrile  affections,  dropsies,  etc.,  etc. 

Dose. — Of  ether,  foss  to  f5j;  of  Hoffmann's  Anodyne,  f.5ss  to 
f5ij,  in  sweetened  water;  of  spirit  of  nitrous  ether,  f5ss  to  f5ss. 

Dental  Uses. — Ether  is  employed  as  a  general  and  local 
anaesthetic ;  as  a  topical  anodyne  in  neuralgia  and  odontalgia, 
for  which  purpose  it  is  generally  combined  with  other  agents ; 
in  aphthae  and  stomatitis ;  as  a  counter-injitant,  evaporation 
being  prevented ;  also  in  saturated  solutions  with  other  agents. 

Sulphuric    Ether  as  an   Anasthetic  Agent. — Sulphuric  ether  is 


252  DENTAL  MEDICINE. 


generally  considered  to  be  a  safer  anaesthetic  agent  than 
chloroform,  as  but  comparatively  few  deaths  have  resulted  from 
its  inhalation;  but  it  is  not  absolutely  free  from  all  dangerous 
effects,  and  when  death  has  ensued  from  its  inhalation  either 
serious  kidney  or  heart  affections  have  been  present.  The  dis- 
covery of  its  anaesthetic  properties  was  first  made  in  1844,  by 
Dr.  Horace  Wells,  a  practicing  dentist,  of  Hartford,  Conn. ;  and 
Dr.  Morton,  of  Boston,  also  a  dentist,  first  demonstrated  the 
application  of  its  anaesthetic  properties  in  dentistry  and  surgery, 
in  1846. 

As  the  physiological  actions  of  both  ether  and  chloroform  are 
similar,  they  may  be  considered  as  follows :  When  the  vapor  of 
ether  or  chloroform  is  inhaled,  the  first  effect  is  faucial  irritation, 
to  a  greater  or  less  degree,  according  to  the  strength  of  the 
agent  employed,  a  feeling  of  suffocation,  with  cough,  a  flow  of 
mucus  and  the  reflex  act  of  swallowing.  The  desire  for  air 
may  cause  more  or  less  struggling,  especially  in  the  case  of 
children.  The  sensibility  of  the  glottis,  however,  is  soon 
relieved,  the  cough  ceases,  and  the  inhalation  of  the  agent 
proceeds  without  further  resistance. 

The  primary  effect  is  a  general  exhilaration;  and,  in  the  case 
of  ether  especially,  it  is  often  one  of  excitement,  which,  in  the 
majority  of  cases,  may  continue  for  a  short  time  only,  while  in 
other  cases,  it  may,  from  its  duration  and  violence,  give  rise  to 
considerable  trouble.  But,  if  the  inhalation  can  be  continued 
and  this  stage  of  excitement  passed  over,  insensibility  soon 
occurs.  The  pulse  increases  in  frequency,  the  respirations 
become  more  rapid,  and  may  assume  a  convulsive  character. 
There  is  flushing  of  the  face,  cerebral  intoxication,  to  a  greater 
or  less  degree,  according  to  the  temperament,  such  as  talking, 
laughing,  singing,  crying,  etc.  In  those  of  a  mercurial  or 
hysterical  disposition  this  stage  of  excitement  is  more  pronounced 
and  persistent,  and  during  its  continuance  sensibility  to  pain  is 
considerably  diminished,  although  the  sense  of  touch  is  still 
preserved,  while  those  of  taste  and  smell  are  lost,  and  complete 
insensibility  soon  follows. 

When  the  patient  is  of  a  full  habit,  and  in  robust  health,  and 


ETHER— ANESTHESIA.  253 

the  inhalation  of  the  anaesthetic  agent  has  been  rapid,  the  stage 
of  complete  insensibility  is  preceded  by  a  convulsive  stage, 
during  which  there  is  rigidity  of  the  voluntary  muscles,  stertorous 
breathing  and  lividity  of  the  face.  If  the  inhalation  of  the 
agent  be  still  further  continued,  the  tetanic  rigidity  of  the 
muscles  subsides,  the  lividity  of  the  face  disappears,  the  breathing 
becomes  quiet,  complete  muscular  relaxation  ensues,  power  of 
movement  is  lost,  as  shown  by  the  arm,  when  raised,  dropping 
without  resistance,  and  the  conjunctiva  of  the  eye,  under 
mechanical  irritation,  being  perfectly  insensible  to  pain.  During 
complete  anaesthesia  the  surface  of  the  face  is  cool  and  bathed  in 
abundant  perspiration  ;  the  countenance  is  calm,  the  eyes  closed 
and  the  pupils  somewhat  contracted,  the  respiration  easy  and 
the  pulse  slower.  The  functions  of  respiration  and  circulation 
continue,  all  others  being  suspended.  From  such  a  condition 
the  patient  will  soon  emerge,  provided  the  further  inhalation  of 
the  agent  be  stopped;  on  the  other  hand,  if  the  inhalation  be 
continued,  the  functions  of  respiration  and  circulation  will  be 
suspended,  and  life  will  end  with  the  cessation  of  the  action  of 
the  heart  and  the  respiratory  organs.  Sudden  death  from  the 
inhalation  of  anaesthetic  agents  is  due  to  paralysis  of  the  cardiac 
ganglia.  When  death  occurs  during  the  stage  of  rigidity  and 
stertorous  breathing,  it  is  due  to  tetanic  fixation  of  the  respiratory 
muscles  and  obstruction  of  the  pulmonary  circulation,  accumu- 
lation of  venous  blood  in  the  heart  and  the  arrest  of  the  heart's 
action. 

Death  may  also  ensue  by  paralvsis  of  the  respiratory  muscles 
during  the  stage  of  complete  muscular  relaxation ;  also  by 
paralysis  of  the  heart  during  complete  insensibility,  the  motor 
ganglia  being  paralyzed. 

Death  may  also  occur  from  depression  of  the  functions  and 
the  shock  of  the  accident,  or  of  the  surgical  operation. 

Mr.  Woodhouse  Braine  divides  anaesthetics  into  two  classes : 
(i)  Those  which  produce  death  through  the  lungs  as  well  as 
through  the  heart;  this  class  includes  chloroform,  bichloride  of 
methylene,  dichloride  of  ethidene,  and  many  others  of  the 
chlorine    series  ;     (2)   those    which    produce    death  through   the 


254  DENTAL  MEDICINE. 


lungs  alone,  the  heart's  action  continuing  for  some  time  after 
respiration  has  quite  ceased  :  this  class  includes  ether  and  nitrous 
oxide  ;  and  he  says,  that  in  choosing  an  anaesthetic  three  factors 
are  to  be  considered:  (i)  The  nature  of  the  operation  ;  (2)  the 
amount  of  insensibility  necessary;  (3)  the  length  of  time  during 
which  insensibility  has  to  be  kept  up;  and  he  sums  up  as 
follows:  (i)  It  is  well  to  avoid  all  anaesthetics  which  tend  to 
depress  the  heart's  action  ;  (2)  for  short  operations  nitrous  oxide 
is  the  best  agent ;  (3)  for  long  operations,  except  where  it  is 
desirable  to  avoid  hemorrhage,  or  where  the  cautery  is  used, 
ether  answers  perfectly  ;  (4)  the  best  time  for  operating  is  the 
early  morning ;  (5)  nitrite  of  amyl  is  the  best  cardiac  stimulant. 

Dr.  W.  M.  Barton  sums  up  the  practical  advantages  of  ether 
as  follows : 

"  I.  The  excitement  stage  is  rarely  seen  except  in  alcoholics, 
and  is  more  violent  if  the  anesthetic  is  hurried. 

"  2.  All  the  time  the  patient  is  kept  under  ether  a  sonorous 
sound  is  heard,  contrary  to  what  passes  with  chloroform,  where 
respiration  is  silent,  so  much  so  that  the  ear  may  have  to  be 
placed  close  to  the  chest  to  hear  respiration.  This  snoring  is 
the  tranquillity  of  the  surgeon ;  his  ear  perceives  it  and  he  is  not 
preoccupied  with  the  condition  of  the  patient.  He  does  not 
have  to  stop  to  ask  '  if  all  is  well ; '  '  if  the  patient  breathes 
well,'  etc. 

"  3.  If  the  anaesthetic  is  given  in  too  large  doses  and  is  ac- 
cumulating, the  snore  is  transformed  into  a  deep  rhoncus,  grave, 
and  less  regular,  the  face  becomes  cyanotic,  the  eye  is  congested. 
It  suffices  to  remove  the  mask  and  to  pull  out  the  tongue  and  all 
is  well.  But  there  never  appears  that  pallid  tint,  that  cadaveric 
look  which  we  see  preceding  a  chloroform  syncope. 

"4.  The  pulse,  very  active  at  first,  soon  slows,  becomes  regu- 
lar, and  is  always  strong  and  vibratory,  contrary  to  chloroform 
narcosis,  in  which  it  is  rapid  and  soft. 

"  5.  The  heart-beats  are  strong.  Here  is  the  indisputable 
advantage  of  ether.  The  etherized  never  have  that  terrible, 
sudden  syncope,  coming  like  a  thunder-bolt  out  of  a  clear  sky, 
followed  by  death,  notwithstanding  all  we  can  do. 


ETHER— AN/ESTHESIA.  255 

"  6.  The  accidents  with  ether  are  purely  respiratory,  slow 
and  progressive,  and  consequently  they  leave  us  time  to  act. 

"  7.  The  operation  terminated,  the  patient  may  recover  per- 
fectly in  one-fourth  to  one-half  of  an  hour  his  normal  anima- 
tion and  color ;  there  is  none  of  that  adynamia  which  we  observe 
with  chloroform.  As  Poncet  has  said,  '  The  chloroformed  are 
in  a  state  of  apparent  death,  the  etherized  in  a  state  of  profound 
intoxication.' 

"  8.  Vomiting  is  certainly  less  frequent  during  and  after 
ether.  Of  course  a  good  deal  of  mucus  comes  up,  but  the 
patient  can  often  eat  an  ordinary  meal  on  the  same  evening. 

"  Such  is  the  comparison.  Ether  stimulates  the  circulation 
and  heart,  so  it  is  especially  precious  in  reduced  patients.  It  is 
certainly  less  dangerous  than  chloroform,  not  only  because  the 
figures  show  this  to  be  the  case,  but  because  the  latter  attacks 
the  bulb  and  produces  vaso-motor  paralysis  and  deleterious  effects 
far  beyond  our  control  to,  limit.  In  ether  the  danger  is  more 
respiratory  ;  it  is  slow  and  we  can  intervene,  often  successfully." 

The  Administration  of  Anesthetics. — To  administer  ether 
or  chloroform,  take  a  folded  piece  of  lint,  of  three  or  four  thick- 
nesses, and  of  a  size  that  can  be  held  conveniently  in  the  hollow 
of  the  fingers  and  palm  of  the  hand ;  and  on  it  pour  the  anaes- 
thetic agent — half  an  ounce  of  ether  or  a  drachm  of  chloroform. 
Some  prefer  a  large  napkin  or  towel,  folded  in  the  form  of  a 
cone,  with  an  opening  of  an  inch  or  an  inch  and  a  half  at  the 
apex,  for  the  admission  of  air.  The  advantage,  however,  of  the 
lint  over  the  folded  napkin  is,  that  by  holding  the  lint  in  the 
hand  but  little  evaporation  occurs.  To  give  sufficient  air  to  the 
patient  when  beginning  the  administration  of  ether.  Dr.  D.  B. 
Keefe  recommends  the  use  of  a  large  towel,  folding  it  first  five 
times  lengthwise,  and  placing  a  piece  of  paper  the  full  length 
between  the  outside  folds,  then  roll  it  up  into  a  cylinder,  the  size 
to  be  governed  by  the  face  of  the  patient :  it  should  be  large 
enough  to  cover  the  face,  but  not  too  large.  This  makes  a 
cylinder  open  at  both  ends,  full  size.  Then  saturate  the  lower 
part  of  the  cylinder,  that  comes  against  the  face,  with  the  ether 
and  apply  it  to  the  face,  and  as  the  other  end  is  open  the  patient 


256  DENTAL  MEDICINE. 


receives  considerable  air  as  well  as  the  ether  vapor.  Before  com- 
mencing the  inhalation,  the  condition  of  the  pulse  should  be 
ascertained  by  placing  the  middle  finger  of  the  left  hand  on  the 
left  temporal  artery,  and  at  the  same  time  endeavor  to  reassure 
the  patient  and  allay  fear  by  cheerful  words.  The  clothes  should 
be  loose,  and  artificial  teeth,  if  any  are  worn,  as  well  as  pins  or 
tobacco,  if  the  habit  of  keeping  them  in  the  mouth  is  indulged 
in,  should  be  removed  before  the  administration  of  the  anesthetic 
is  commenced,  to  prevent  them  from  slipping  into  the  larynx 
and  causing  death.  The  patient  should  be  directed  not  to  par- 
take of  any  food  for  twelve  hours  preceding  the  administration 
of  ether  in  order  to  avoid  vomiting,  except  a  little  milk  or  tea 
one  or  two  hours  before  its  administration — a  piece  of  wet  muslin 
mav  be  placed  over  the  eyes — to  prevent  the  vapor  or  liquid  from 
causing  irritation.  The  inhalation  should  be  commenced  by 
holding  the  moistened  lint  or  towel  three  or  four  inches  from  the 
patient's  face,  directing  him  to  breathe  quite  naturally,  always 
remembering  that  a  strong  atmosphere  in  the  early  stages  of  the 
inhalation  is  dangerous,  and  carefully  watching  for  coughing  or 
acts  of  swallowing,  when,  if  any  such  occur,  the  lint  or  towel 
should  be  moved  further  away,  and  approached  again  more 
gradually.  If  the  patient  shows  ho  signs  of  the  anaesthetic  vapor 
being  too  strong,  the  lint  or  towel  may  be  gradually  brought  to 
within  an  inch  and  a  half  of  the  patient's  mouth  and  nostrils; 
and  to  still  more  concentrate  the  atmosphere,  if  lint  is  used,  the 
hand  holding  it  may  be  covered  with  one  fold  of  an  ordinary 
large  napkin,  which  may  hang  loose  over  the  mouth  and  chin, 
but  should  be  so  arranged  above  that  the  patient's  eyes  and  fore- 
head may  remain  uncovered  and  visible.  The  inhalation  should 
be  commenced  cautiously,  by  instructing  the  patient  to  breathe 
quite  naturally,  and  to  obey  any  direction  to  raise  the  hand  or 
open  the  eves. 

When  the  inhalation  has  fairly  commenced,  it  should  be  con- 
tinued until  there  is  no  winking  when  the  margins  of  the  eyelids 
are  touched,  or  the  hand  cannot  be  raised,  and  the  limbs  are  per- 
fectly relaxed,  when  the  patient  is  ready  for  the  operation  ;  what 
is  termed  the  "  surgical  period  "  having  arri-ved.     An  inhalation 


ETHER— ANESTHESIA.  257 

with  chloroform  generally  takes  about  four  minutes;  often  more; 
seldom  less.  With  ether,  the  time  required  is  longer  and  the 
quantity  of  the  agent  greater. 

It  should  also  be  remembered  that,  in  summer,  chloroform  and 
ether  evaporate  more  readily  than  in  the  colder  seasons. 

The  operator  should  devote  his  undivided  attention  to  the 
patient,  during  the  inhalation  of  anaesthetics.  One  finger  should 
be  kept  on  the  pulse,  and  the  respiration  should  be  carefully 
noted  ;  for  the  latter  is  of  more  importance  than  the  former, 
although  the  pulse  is  by  no  means  to  be  neglected.  When  the 
patient  becomes  excited,  he  should  be  watched  very  closely,  and 
if  the  respiration  becomes  proportionately  quickened,  so  must 
the  vapor  of  the  anaesthetic  be  proportionately  weakened,  by 
withdrawing  the  lint  or  towel  slightly  from  the  face. 

When  the  muscles  become  rigid,  and  the  patient  holds  his 
breath  and  becomes  livid,  the  anaesthetic  should  be  given  very 
weak  indeed,  as  such  a  state  of  semi-asphyxiation,  due  to  the 
suspension  of  respiration,  is  often  followed  by  extreme  rapidity 
and  depth  of  respiration,  and  a  dangerous  condition  is  apt  to 
supervene,  because  anaesthesia  is  added  to  asphyxia.  The  cu- 
mulative action  of  these  general  anaesthetics  should  also  be  re- 
membered, for  a  state  of  narcosis  frequently  intensifies  for  half 
a  minute  or  more  after  the  suspension  of  the  administration, 
which  is  due  to  the  vapor  of  the  anaesthetic  which  was  in  the 
lungs  entering  the  blood  after  the  administration  ceases. 

Prof.  J.  J.  Chisholm,  of  the  University  of  Maryland,  gives  the 
following  five  simple  rules  for  the  administration  of  chloroform, 
and  which  will  apply  to  ether  also  : — 

"  I.  I  always,  without  a  single  exception,  give  a  strong  drink 
of  whiskey,  from  one  to  two  ounces,  to  every  adult  to  whom  I 
intend  to  administer  chloroform.  This  is  done  a  few  minutes 
before  the  operation. 

"  2.  Always  loose  the  neck  and  chest  clothing,  so  as  to  have 
no  impediment  to  respiration. 

"  3.     Only  administer  chloroform  in  the  recumbent  posture, 
with  body  perfectly  horizontal  and  head  on   a  low  pillow,  this 
pillow  to  be  removed  as  the  anjesthesia  progresses. 
17 


258  DENTAL  MEDICINE. 


"  4.  Give  chloroform  on  a  thin  towel,  folded  in  conical  form, 
with  open  apex,  so  that  the  vapor,  before  inhalation,  will  be  freely 
diluted  with  atmospheric  air.  In  holding  this  cone  over  the  face 
of  the  patient,  at  some  little  distance  from  the  nose,  place  the 
fingers  under  the  borders  of  the  cone,  for  the  double  purpose  of 
allowing  the  air  to  enter  freely,  and  also  to  prevent  the  chloro- 
form liquid  on  the  towel  from  coming  in  contact  with  the  skin  of 
the  patient's  face,  and  thereby  avoid  its  blistering  effects. 

"5.  Should  loud  snoring  occur,  force  up  the  chin.  This 
manipulation,  by  straightening  the  air  passages  from  the  nose  to  the 
larynx,  makes  easy  breathing.  The  forcible  elevation  of  the  chin 
is  far  better  in  every  respect  than  pulling  out  the  tongue.  It  is  easier 
of  application,  more  quickly  done,  requires  no  instrument,  and  is 
much  more  efficient  in  removing  the  impediment  to  respiration. 

"  While  operating,  I  have  constantly  in  view  both  the  color  of 
the  face  and  the  respiration  of  the  patient,  which  I  consider  even 
more  important  for  the  surgeon  to 'observe  than  to  feel  the  pulse." 
(  See  "  Chloroform  "  for  further  directions  and  precautions  to  be 
observed  during  the  administration  of  this  agent.) 

Dr.  H.  A.  Hare  states  that  if  during  anaesthesia,  respiration 
stops,  he  has  found  that  in  a  large  number  of  instances,  both  in 
man  and  in  the  lower  animals,  the  free  use  of  ether  poured  upon 
the  belly  causes  so  great  a  shock,  by  the  cold  produced  by  its 
evaporation,  as  to  cause  a  very  deep  inspiration,  which  is  often 
followed  by  the  normal  respiratory  movements. 

Dr.  H.  I.  Neilson  gives  the  following  conclusions  concern- 
ing the  pupil  as  a  guide  in  the  administration  of  chloroform  : 

1.  The  first  effect  of  chloroform  narcosis  on  the  pupils  con- 
sists in  a  dilatation  which  varies  in  intensity  and  duration  in  dif- 
ferent individuals.  As  the  anaesthesia  becomes  more  profound 
the  pupils  begin  to  contract  and  finally  become  very  small  and 
immovable.  If  now  the  chloroform  is  pushed  still  further,  a 
sudden  dilatation  occurs,  which  is  the  result  of  asphyxia,  from 
which  the  patient  seldom  recovers. 

2.  As  long  as  the  pupil  is  observed  to  dilate  in  response  to 
sensory  stimuli,  such  as  pinching  the  skin,  the  anaesthesia  is  not 
yet  sufficient  to  allow  the  commencement  of  the  operation. 


ETHER— ANy*:STHESIA.  259 

3.  As  soon  as  the  pupil  becomes  strongly  contracted  and  im- 
movable, the  administration  of  the  anaesthetic  must  be  suspended, 
until  a  commencing  dilatation  is  observed,  and  the  patient  must 
be  held  at  just  this  point  as  long  as  the  operation  continues. 

4.  Vomiting  causes  a  dilatation  similar  to  that  occurring  as  the 
patient  emerges  from  the  narcotic  condition,  but  it  is  usually 
more  sudden  in  the  former  case.  The  contraction  of  the  pupils 
does  not  appear  to  begin  until  the  blood-pressure  is  somewhat  re- 
duced, and  the  dilatation  proceeds  pari  passu  with  the  increase  in 
the  blood-pressure.  He  therefore  regards  the  appearance  of  the 
pupil  as  a  very  reliable  guide  for  the  administration  of  chloro- 
form, as  he  is  enabled  to  judge  accurately  concerning  the  condi- 
tion of  the  patient. 

When  ether  or  chloroform  is  administered  for  the  extraction 
of  teeth,  the  operation  should  be  performed  in  a  dental  chair  so 
constructed  as  to  admit  of  the  patient  being  placed  in  as  hori- 
zontal a  position  as  is  possible  to  operate  successfully,  and  every 
instrument  it  is  necessary  to  use  should  be  within  reach  of  the 
hand  of  the  operator.  As  soon  as  the  operation  is  completed  the 
head  of  the  patient  should  be  gently  inclined  to  the  side,  so  as  to 
permit  the  blood  to  run  from  the  mouth  and  not  pass  down  the 
throat.  Any  considerable  change  in  the  position  of  the  patient 
should  be  avoided  until  recovery  has  taken  place.  Fresh  air 
should  be  admitted  by  lowering  the  window,  and  the  patient  freely 
supplied  with  it  by  means  of  a  fan. 

The  vapor  from  a  mixture  composed  of  equal  parts  of  chloro- 
form and  alcohol  has  been  combined  with  the  nitrous  oxide  gas. 
This  vapor  from  two  or  three  drops  of  the  chloroform  and  alco- 
hol mixture  is  used  with  each  gallon  of  gas,  the  anaesthetic  effect 
of  which,  it  is  claimed,  is  more  lasting,  and  at  the  same  timeless 
dangerous,  than  from  either  of  the  two  agents  alone.  An  appa- 
ratus for  combining  these  two  agents  is  in  use,  which  is  attached  to 
the  gas  cylinder,  in  place  of  the  ordinary  connection.  (  See  the 
combinations  of  oxygen  and  air  with  nitrous  oxide,  under  Ni- 
trous Oxide.  ) 

The  administration  of  anaesthetics  through  the  nose  has  been 
suggested  by    Dr.   B.  C.  A.  Windle,  of  England,  a  peculiar  in- 


260  DENTAL  MEDICINE. 


strument  being  employed  for  pumping  the  vapor  of  the  anaesthetic 
through  a  tube  which  passes  into  one  nostril;  wings,  to  close  the 
outer  surface  of  the  nostril  containing  the  tube  and  the  opposite 
surface  of  the  septum  nasi,  are  attached  to  the  tube,  so  that  air 
may  pass  through  the  passage  unoccluded  by  the  tube.  The  in- 
ventor of  this  method  claims  that  by  its  use  perfect  anaesthesia 
can  be  maintained  throughout  an  operation  about  the  face,  of  any 
length,  without  interfering  with  the  operator's  actions  ;  also,  that 
in  operations  about  the  mouth  and  palate  the  patient  can  be  main- 
tained at  that  point  of  anaesthesia  which  may  be  considered  de- 
sirable, and  that  the  supply  can  be  regulated. 

Dr.  Axel  Yversen,  of  Copenhagen,  suggested  etherization  by 
the  rectum,  the  vapor  being  conducted  to  the  rectum  by  a  rubber 
tube  (attached  to  a  bottle  containing  the  ether,  in  a  water  bath  of 
120°),  terminating  in  a  recurrent  catheter,  the  free  or  recurrent 
end  being  closed  by  pressure  of  the  thumb  during  the  inflation  of 
the  bowel;  the  expiratory  act  being  performed  by  removing  this 
pressure  and  the  water  bath.  The  principal  advantage  this 
method  appears  to  possess  is  that  it  permits  operations  on  the 
face  without  the  ordinary  obstacles  of  the  common  method. 

Dr.  Thomas  Fillebrown  suggests  a  new  apparatus  for  main- 
taining anaesthesia  without  a  face-piece,  and  with  the  mouth 
open.  The  apparatus  consists  of  a  bellows,  connected  by  rubber 
tubing  with  the  long  tube  of  a  12-ounce  wash-bottle,  with  a  stop- 
cock to  regulate  the  flow  of  air.  From  the  bottle  extends  a  half- 
inch  rubber  tube  to  the  patient.  The  bellows  is  inflated,  and  the 
stop-cock  opened  so  as  to  allow  the  air  to  bubble  up  freely- 
through  the  ether,  and  to  become  saturated  with  ether  vapor. 
The  etherized  air  is  then  discharged  through  the  second  tube  a 
few  inches  from  the  patient's  face.  It  is  claimed  that  such  an 
application  of  ether  will  maintain  complete  anaesthesia  for  any 
length  of  time,  and  not  interfere  in  the  least  with  any  operation 
in  or  about  the  mouth ;  nor  will  the  surplus  vapor  discharged 
into  the  air  sensibly  affect  either  the  operator  or  the  assistants ; 
also,  that  the  anaesthesia  can  be  maintained  from  one-half  hour 
to  one  hour  and  a  half  without  intermitting  the  operation  at  all 
on  account  of  the  anaesthesia;  that  this  method  is  not  wasteful. 


ETHER— ANAESTHESIA.  261 

The  Dangers  of  Anaesthesia. — The  conditions  rendering 
general  anaesthetics  dangerous  are  fatty  degeneration  of  the  heart 
(a  prominent  contraindication);  previous  alcoholic  habits;  brain 
tumors  and  degenerations  ;  respiratory  obstruction  from  swollen 
epiglottis,  enlarged  tonsils,  oedema  glottidis,  laryngeal  paralysis, 
thoracic  tumors  or  aneurism ;  emphysema  and  obstructed  pulse 
circulation  from  engorgement  of  right  heart  and  deficient  heart 
power;  valvular  lesions;  incomplete  anaesthesia  during  painful 
surgical  operations,  causing  death  from  shock,  as  the  result  of 
peripheral  irritation.  Muscular  debility  and  weakness  from  ex- 
haustion, if  otherwise  uncomplicated,  are  considered  to  be  rather 
aids  to  anaesthesia  than  contraindications. 

Preventive  Measures  Against  the  Dangers  of  Anaes- 
thesia.— A  thorough  examination  for  sources  of  danger  should 
always  be  made  previous  to  the  administration  of  the  anaesthetic. 
An  anaesthetic  should  never  be  administered  on  a  full  stomach, 
as  an  anaesthesia  of  the  glottis  prevents  the  expulsion  of  vomited 
matter  from  the  larynx,  in  case  it  enters  by  regurgitation.  An 
anaesthetic  should  never  be  administered  after  long  fasting,  as 
absence  of  nutrition  may  tend  toward  cardiac  paralysis.  One  or 
two  ounces  of  whiskey  should  be  administered  immediately  be- 
fore the  operation.  All  excitement  should  be  avoided,  to  the 
patient,  from  fear,  sight  of  instruments,  too  many  spectators,  etc., 
all  of  which  tend  to  induce  shock.  All  appliances  for  resuscita- 
tion should  be  at  hand,  and  plenty  of  fresh  air  be  available  during 
the  inhalation.  In  using  chloroform  mix  only  three  and  a-half 
per  cent,  of  the  vapor  with  air,  to  insure  safety.  In  the  admin- 
istration of  ether  the  respirations,  according  to  some  authorities, 
alone  need  be  watched  :  in  chloroform,  however,  both  the  respi- 
rations and  the  pulse  should  be  carefully  noted. 

Treatment  of  Dangerous  Symptoms  of  Anaesthesia. — 
The  suspension  of  the  heart's  action  necessitates  the  immediate 
withdrawal  of  the  vapor  and  the  immediate  inversion  of  the 
patient,  according  to  Nekton's  method.  The  failure  of  respira- 
tion necessitates  the  forcing  up  of  the  chin,  or  the  forcible  draw- 
ing out  of  the  tongue  to  lift  the  epiglottis;  the  practice  of  arti- 
ficial respiration   by  the  Sylvester  method,  and  by  faradization  of 


262  DENTAL  MEDICINE. 


the  respiratory  muscles ;  the  inhalation  of  gtt.  iij  to  gtt.  iv  of 
nitrite  of  amyl ;  ammonia  to  the  nostrils ;  galvanism  (the  positive 
pole  being  placed  to  the  nostril,  and  the  negative  pole  over  the 
diaphragm,  to  excite  a  reflex  action  between  the  fifth  pair  and 
the  pneumo-gastric,  or  the  poles  may  be  placed  directly  over  both 
phrenic  nerves,  on  a  line  with  the  fourth  cervical  vertebra,  in 
order  to  stimulate  respirations ;  or  one  pole  may  be  placed  over 
the  upper  dorsal  spinous  process,  and  the  other  pole  over  the 
apex  of  the  heart,  to  induce  cardiac  contraction).  Artificial 
warmth  should  be  applied,  but  no  cold  applications. 

The  inversion  of  the  body  according  to  Nelaton's  method,  and 
artificial  respiration,  according  to  Sylvester's  method  or  Marshall 
Hall's  ready  method,  or  Howard's  method,  are  safe  and  are  the  most 
promising  expedients.  A  simple  method  of  producing  artificial 
respiration  is  as  follows  : — 

"  With  outspread  palms,  press  the  front  of  the  chest  forcibly 
down,  whilst  an  assistant  at  the  same  time  presses  the  abdomen. 
Make  these  movements  not  oftener  than  fifteen  times  in  the 
minute." 

DR.  H.  R.  Sylvester's  method  of  resuscitationt. 

"  To  Adjust  the  Patient's  Position. — Place  the  patient  on  his 
back,  on  a  flat  surface;  raise  and  support  the  head  and  shoulders 
on  a  small,  firm  cushion,  or  folded  article  of  dress,  placed  under 


the   shoulder-blades ;  remove   all   tight   clothing   about  the  neck 
and  chest. 


ETHER— ANAESTHESIA.  263 


"  To  Maintain  a  Free  Entrance  of  Air  into  the  Windpipe. — 
Cleanse  the  mouth  and  nostrils ;  open  the  mouth  ;  draw  forward 
the  patient's  tongue  and  keep  it  forward  ;  an  elastic  band  over 
and  under  the  chin  will  answer  the  purpose. 

"■  To  Imitate  the  Movements  of  Breathing  : — 

"  First^  Induce  Inspiration. — Place  yourself  at  the  head  of  the 
patient;  grasp  his  arms;  raise  them  upward  by  the  sides  of  his 
head  ;  stretch  them  steadily  but  gently,  upward  and  backward, 
for  two  seconds.  By  this  means  fresh  air  is  drawn  into  the 
lungs,  by  raising  the  ribs. 

"  Secondly.,  Induce  Expiration. — Immediately  turn  down  the 
patient's    arms,  and    press    them    firmly,  but   gently,  downward 


against  the  sides  of  his  chest,  for  two  seconds.     By  this  means 
foul  air  is  expelled  from  the  lungs,  by  depressing  the  ribs. 

"  Thirdly.,  Continue  these  Movements. — Repeat  these  movements 
alternately,  deliberately  and  perseveringly,  fifteen  times  in  a 
minute,  until  a  spontaneous  effort  to  respire  be  perceived.  By 
this  means  an  exchange  of  air  is  produced  in  the  lungs,  similar 
to  that  effected  by  natural  respiration." 

MARSHALL    HALL's    READY    METHOD  IN    ASPHYXIA. 

"  1st.  Treat  the  patient  instantly.,  on  the  spot.,  in  the  open  air., 
freely  exposing  the  face,  neck  and  chest  to  the  breeze,  except  in 
severe  weather. 

"  2d.  In  order  to  clear  the  throat.,  place  the  patient  gently  on 
the  face,  with  one  wrist  under  the  forehead,  that  all  fluid,  and  the 
tongue  itself,  may  fall  forward,  and  leave  the  entrance  into  the 
windpipe  free. 


264  DENTAL  MEDICINE. 

"  3d.  To  excite  respiration^  turn  the  patient  slightly  on  his  side, 
and  apply  some  irritating  or  stimulating  agent  to  the  nostrils,  as 
Veratrine^  dilute  Jmmonia^  etc. 

"4th.  Make  the  face  warm  by  brisk  friction;  then  dash  cold 
water  upon  it. 

"  5th.  If  not  successful,  lose  no  time;  but,  to  imitate  respira- 
tion^ place  the  patient  on  his  face,  and  turn  the  body  gently,  but 
completely,  on  the  side  and  a  little  beyond ;  then  again  on  the  face, 
and  so  on,  alternately.  Repeat  these  movements  deliberately  and 
perseveringly,  y5/>^^«  times  only  in  a  minute.  (When  the  patient 
lies  on  the  thorax,  this  cavity  is  compressed  by  the  weight  of  the 
body,  and  ^;fpiration  takes  place.  When  he  is  turned  on  the 
side,  this  pressure  is  removed,  and  /aspiration  occurs.) 

"  6th.  When  the  prone  position  is  resumed,  make  a  uniform 
and  efficient  pressure  along  the  spine,  removing  the  pressure  im- 
mediately before  rotation  on  the  side.  (The  pressure  augments 
the  expiration ;  the  rotation  commences  /V/spiration.)  Continue 
these  measures. 

''7th.  Rub  t;he  limbs  upward,  with  Jirm  pressure  and  with 
energy.  (The  object  being  to  aid  the  return  of  venous  blood  to 
the  heart.) 

"  8th.  Substitute  for  the  patient's  wet  clothing,  if  possible, 
such  other  covering  as  can  be  instantly  procured,  each  bystander 
supplying  a  coat  or  cloak,  etc.  Meantime  and  from  time  to 
time,  to  excite  inspiration,  let  the  surface  of  the  body  be  slapped 
briskly  with  the  hand. 

"  9th.  Rub  the  body  briskly  till  it  is  dry  and  warm,  then 
dash  cold  water  upon  it  and  repeat  the  rubbing. 

"  Avoid  the  immediate  removal  of  the  patient,  as  it  involves  a 
dangerous  loss  of  time ;  also  the  use  of  bellows,  or  any  forcing  in- 
strument ;  also,  the  warm  bath  and  all  rough  treatment." 

DR.  Howard's    method  of   resuscitation. 

One  of  the  most  efficient,  as  well  as  the  most  recent  method, 
is  that  of  Dr.  Howard  for  performing  artificial  respiration. 

Position  of  Patient. — Face  upward,  a  hard  roll  of  clothing  be- 
neath the  thorax,  with  shoulders  slightly  declining  over  it.     (One 


ETHER— ANAESTHESIA.  205 

twist  of  handkerchief  around  the  crossed  wrists  will  keep  them 
there,)      Rip  or  strip  clothing  from  waist  and  neck. 

Position  of  Operator. — Kneel  astride  the  patient's  hips ;  place 
your  hands  upon  his  chest,  so  that  the  ball  of  each  thumb  and 
little  finger  rests  upon  the  inner  margin  of  the  free  border  of  the 
costal  cartilages,  the  tip  of  each  thumb  near  or  upon  the  xiphoid 
cartilage,  the  fingers  fitting  in  the  corresponding  intercostal 
spaces.  Fix  your  elbows  firmly,  making  them  even  with  your 
sides  and  hips;  then  — 

Jetton  of  Operator. — Pressing  upward  and  inward  toward  the 
diaphragm,  use  your  knees  as  a  pivot,  and  throw   your  weight 


slowly  forward  two  or  three  seconds  until  vour  face  almost 
touches  that  of  the  patient,  ending  with  a  sharp  push,  which 
helps  to  jerk  you  back  to  your  erect  kneeling  position.  Rest 
three  seconds,  then  repeat  this  bellows-blowing  movement  as  be- 
fore, continuing  it  at  the  rate  of  seven  to  ten  times  a  minute, 
taking  the  utmost  care  on  the  occurrence  of  a  natural  gasp, 
gently  to  aid  and  to  deepen  it  into  a  longer  breath,  until  respira- 
tion becomes  natural.  When  practicable,  have  the  tongue  held 
firmly  out  of  one  corner  of  the  mouth  with  thumb  and  finger 
armed  with  a  dry  cotton  rag. 

Very  frequentiv  during  the  early  stages  of  the  administration 
of  an  anaesthetic  the  patient  may  "  forget  to  breathe,"  even  before 
the  ability  to  perceive  peripheral  irritation  is  lost.      Even  later  in 


266  DENTAL  MEDICINE. 

the  anaesthesia,  when  the  breathing  suddenly  ceases,  instead  of 
using  cold  water  externally  and  slapping  the  patient  with  wet 
towels,  Dr.  H.  A.  Hare  recommends  pouring  a  quantity  of  ether 
upon  the  belly,  the  shock  caused  by  the  cold  produced  by  its 
evaporation  bringing  on  a  very  deep  inspiration,  followed  often 
by  the  normal  respiratory  movements. 

Local  Anaesthesia. — The  fatality  attending  the  use  of  general 
anaesthetics  led  to  the  introduction  of  what  are  termed  "  local 
anaesthetics,"  some  of  which  depend  upon  the  therapeutic  prop- 
erty of  cold,  which  is  properly  an  anaesthetic  only  when  it  freezes 
the  part  to  which  it  is  applied.  The  use  of  cold  for  such  a  pur- 
pose must  necessarily  be  limited  to  small  parts  of  the  body,  and 
its  utility  depends  upon  the  ease  and  rapidity  with  which  a  de- 
sired spot  of  living  flesh  can  be  frozen,  in  other  words,  tempo- 
rarily deprived  of  its  vitality,  without  inflicting  mechanical  injury 
on  the  delicate  structure  of  the  part. 

According  to  Dr.  Richardson,  the  proposer  of  the  method,  the 
principle  consists  in  directing  on  the  part  of  the  body  a  volatile 
liquid,  having  a  boiling  point  at  or  below  blood  heat,  in  a  state 
of  fine  subdivision  or  spray,  such  subdivision  being  produced  by 
the  action  of  air  or  other  gaseous  substance  on  the  volatile  oil  to 
be  dispersed.  When  it  falls  on  a  part  of  the  body,  it  comes 
with  force  into  the  most  minute  contact  with  the  surface  upon 
which  it  strikes. 

As  a  result,  there  is  rapid  evaporation  of  the  volatile  fluid,  and 
so  great  an  evolution  of  heat  force  from  the  surface  of  the  part 
to  which  the  spray  is  applied,  that  the  blood  cannot  supply  the 
equivalent  loss.  The  part  consequently  dies  for  the  moment,  and 
is  insensible ;  but  as  the  power  of  the  body  is  unaffected,  the 
blood,  as  soon  as  the  external  reducing  agency  is  withdrawn, 
quickly  makes  its  way  again  through  the  dead  parts,  and  restora- 
tion rapidly  occurs. 

•  The  fluids  used  are  ether,  of  a  specific  gravity  not  exceeding 
0.723,  highly  rectified,  and  as  free  as  possible  from  either  alcohol 
or  water — what  is  known  as  "  absolute  ether" — and  rhigolene,  a 
product  of  petroleum,  and  the  lightest  liquid  known,  ethyl  or 
methyl  chloride,  and  pental. 


LOCAL   AN^STHESL\.  ,         267 

When  a  current  of  the  volatile  liquid,  either  atomized  ether 
or  rhigolene,  comes  in  contact  with  the  skin  by  the  use  of  the 
sprav  apparatus,  an  intense  degree  of  cold  is  produced,  which 
deprives  the  nerves  of  the  part  of  their  power  to  transmit  im- 
pressions to  the  sensorium.  For  the  extraction  of  teeth,  destruc- 
tion of  the  pulps  of  teeth,  opening  abscesses,  and  other  minor 
surgical  operations,  and  neuralgia  of  superficial  nerves,  success 
has  attended  the  use  of  such  local  anaesthetics.  The  greatest  ob- 
jections to  such  a  method  of  inducing  local  anaesthesia,  are  the 
great  pain  which  attends  the  first  application,  and  the  unpleasant 
burning  sensation  of  the  part  when  it  is  recovering  from  the 
freezing  process.  (See  Rhigolene.)  (See  Aconite,  for  obtunding 
mixture.) 

Liquefied  chloride  of  methyl  dissolved  in  ether  and  carefully 
applied  by  means  of  a  hair  pencil,  is  recommended  for  the  pain- 
less extraction  of  teeth,  the  opening  of  alveolar  abscesses,  etc., 
etc.  (See  Cocaine,  Tropacocaine,  Beta-Eucaine,  Vapocaine,  and 
Chloretone,  as  local  anaesthetics.) 

A  plan  of  local  anaesthesia,  known  as  Voltaic  Narcotism^  has 
been  suggested  by  Dr.  Richardson,  of  London.  It  consists  in 
passing  a  galvanic  current  through  a  narcotic  solution  held  in 
contact  with  the  part  to  be  operated  upon.  This  plan  appears  to 
be  successful  only  where  the  cavity  of  the  tooth  to  be  extracted 
is  exposed. 

Electro-magnetism  has  also  been  employed  as  a  local  anaes- 
thetic, and  it  is  a  mooted  question  whether  it  relieves  pain  or 
complicates  the  sensations.  It  is  well,  however,  to  remember 
that  some  persons  are  so  peculiarly  constituted  as  to  render  them 
very  susceptible  to  the  influence  of  electricity.  Dr.  Scott  de- 
scribes his  method  of  applying  electricity  for  the  extraction  of 
teeth  as  follows :  "  Use  a  Kidder  electro-magnetic  machine,  or 
any  other  giving  very  rapid  vibrations  of  armature.  Place  the 
positive  electrode  on  the  gum  of  the  tooth  to  be  extracted,  and 
the  negagve  in  the  patient's  hand,  or  at  the  back  of  the  neck. 
Start  with  a  light  current  and  gradually  increase  the  strength  as 
much  as  can  be  borne  without  producing  pain.  The  electrode 
applied  to  the  tooth  should  embrace  each  side,  the  better  to  con- 


268  DENTAL  MEDICINE. 


vey  the  current.  For  this  purpose  it  should  be  bifurcated  at  the 
end  of  the  handle,  the  arms  of  sufficient  length  for  convenience 
in  operating.  At  the  end  of  these  solder  small  disks  about  the 
size  of  a  dime.  The  handle  and  arms  must  be  insulated  to  pre- 
vent the  current  passing  off  at  any  other  point  than  the  disks. 
Cover  the  disks  with  thin  pads  of  fine  sponge.  A  cylinder 
electrode,  also  covered  with  fine  sponge  or  cloth,  is  the  proper 
one  for  the  hand.  Moisten  each  with  saline  water.  Another 
method  is  to  attach  one  pole  of  the  battery  to  the  extracting  for- 
ceps, the  handles  of  which  are  well  insulated,  the  other  pole  being 
held  in  the  hands  of  the  patient.  As  soon  as  the  forceps  come 
in  contact  with  the  tissues  about  the  tooth  the  circuit  is  com- 
pleted, and  the  electrical  effect  produced,  which  is  often  painful. 
A  committee  of  the  College  of  Dentists,  England,  in  a  report 
upon  the  anaesthetic  value  of  electricity,  were  unanimous  that  in 
no  case  was  local  anaesthesia  produced  by  such  currents,  but  that 
the  effects  were  due  to  "  diversion  of  sensation,  less  difficulty  of 
extraction  as  compared  with  other  extractions,  syncope  more  or 
less  marked,  and  differences  in  methods  of  operating."  (See 
Electricity  as  a  Therapeutic  Means,  etc.) 

Obtunding  mixtures,  consisting  of  a  combination  of  cocaine, 
eucaine,  tropacocaine,  chloretone,  pyrethrum,  aconite,  chloral, 
veratria  and  alcohol,  or  chloroform,  aconite,  belladonna,  opium 
and  carbolic  acid,  etc.,  have  been  employed  to  produce  local 
anaesthesia,  and  in  many  cases  with  satisfactory  results.  (See  rec- 
ipes for  obtunding  mixtures  and  local  anaesthetics.)  For,  although 
entire  insensibility  to  pain  cannot  in  all  cases  be  brought  about, 
yet  some  diminution  of  it  may  be  effected  by  the  use  of  such 
agents.  They  have  the  merit,  at  least,  of  being  less  dangerous 
than  the  general  anaesthetics.  Such  topical  pain-obtunding  mixtures 
are  best  applied  to  the  parts  about  the  neck  and  over  the  root  of  a 
tooth  by  means  of  a  simple  apparatus,  devised  by  Von  Bonhorst. 
It  consists  of  two  small  metallic  cups,  attached  to  the  free  ends 
of  a  spring  some  seven  inches  long,  and  which  contain  sponges 
to  hold  the  liquid.  When  used,  the  sponges  in  the  cups  are  sat- 
urated with  the  obtunding  mixture  and  applied  by  pressing  them 
on  the  gum  on  each  side  of  the  tooth  to  be  removed,  where  they 


LOCAL   ANVESTHESL\.  269 

are  retained  from  one-half  to  two  minutes.  Previous  to  the  ap- 
plication the  patient  should  be  cautioned  against  swallowing  any 
portion  of  the  mixture.     (See  Cocaine,  hypodermic  use  of.) 

Pressure  Anasthesia  by  Compressed  Air. — Compressed  air  is 
recommended  as  essential  to  the  dentist  for  relieving  the  pain  of 
many  operations,  and  also  for  securing  better  results  in  the  action 
of  certain  remedial  agents  by  bringing  them  in  closer  contact 
with  the  tissues  to  be  anaesthetized.  It  has  been  successfully 
employed  by  a  method  which  consists  in  forcing,  by  compressed 
air  with  an  even  and  constant  force,  an  obtunding  agent  into  the 
tubuli  of  the  dentine,  in  cases  of  hypersensitiveness.  It  is  a 
more  simple  method  of  obtunding  than  that  of  cataphoresis, 
electricity  being  the  pressure  in  the  cataphoric  method. 

Some  twenty-hve  to  thirty  or  forty  pounds  of  air-pressure  are 
sufficient,  which  can  be  secured  by  an  apparatus  designed  for  the 
purpose,  which  will  produce  double  the  amount  of  pressure  in  air 
than  in  water.  A  solution  of  cocaine  in  sulphuric  ether  — 
vapocaine,  for  example,  has  the  advantage  of  easy  access  to  the 
tubuli  of  the  dentine,  on  account  of  the  ether  holding  the  cocaine 
and  finding  its  way  into  the  tubuli,  when  it  evaporates  leaving  the 
cocaine,  which  then  combines  with  the  fluid  present. 

Besides  its  use  as  an  obtundent  of  sensitive  dentine,  com- 
pressed air  may  also  be  used  to  diffuse  medicines  in  root-canals, 
and  into  the  pus-pockets  of  alveolar  pyorrhcea,  in  bleaching 
teeth,  in  forcing  out  blood  and  pus  in  pyorrhcea,  in  forcing  back 
the  gum  and  contents  of  such  pockets,  as  a  spray,  and  as  a  dessi- 
cant  of  pulp-canals,  in  drying  cavities  in  teeth,  and  also  drying 
the  mouth  in  rapidly  hardening  cement  fillings  with  warm  air,  in 
cooling  impressions  of  modeling  compound,  or  wax,  in  keeping 
dry  the  banding  of  a  root  by  forcing  back  the  blood  and  gum,  in 
setting  crowns  and  bridge-work,  etc.  In  the  apparatus  em- 
ployed, the  outlet  of  air  is  under  control  so  as  to  secure  an  even 
and  constant  pressure,  and  the  supply  is  controlled  by  a  cut-off. 

Liquid  Air. — The  temperature  of  liquid  air  is  312°  F.  below 
zero.  It  is  applied  in  the  form  of  spray.  Liquid  air  has  re- 
ceived attention  from  a  surgical  standpoint  in  regard  to  its  ef- 
ficacy as  a  local  anaesthetic,  in  the  treatment  of  ulcers,  opening 


270  DENTAL  MEDICINE. 

abscesses,  for  relief  of  facial  and  other  forms  of  neuralgia,  sciat- 
ica, herpes  zoster,  erysipelas,  etc.  Dr.  A.  C.  White  states, 
after  experimenting  with  liquid  air,  "  I  first  began  the  use  of 
liquid  air  in  the  local  treatment  of  ulcers  of  the  leg  chiefly 
varicose,  many  chaucroids  and  some  specific  ulcers.  So  many  of 
these  cases  have  now  been  treated  with  liquid  air  that  it  can  be 
said  with  positiveness  that  we  have  nothing  at  our  disposal  to- 
day which  will  so  quickly,  thoroughly,  and  with  so  little  pain 
clear  up  the  edges  and  stimulate  the  surface  of  an  ulcer  to 
granulations  as  liquid  air  does  when  properly  applied.  The  ap- 
plication should  not  be  made  so  frequently  as  to  break  down  the 
new  granulations  as  they  form.  After  the  first  two  applications 
to  an  ulcer,  one  application  a  week  is  usually  sufficient.  All 
ulcerations  treated  with  liquid  air  seem  to  do  better  when  fol- 
lowed by  a  dry  dressing,  such  as  aristol,  subgallate  of  bismuth, 
or  stearate  of  zinc  instead  of  any  unguent.  An  abscess,  boil,  or 
carbuncle,  in  the  early  stage  is  aborted  absolutely  in  one  thorough 
freezing.  If  it  is  more  advanced,  several  applications  at  intervals 
of  twenty-four  hours  are  necessary.  Whenever  pus  has  formed 
in  large  quantity  it  is  advisable  to  anaesthetize  with  liquid  air, 
incise  and  evacuate.  In  case  of  carbuncle  and  bubo  well  ad- 
vanced, it  is  unnecessary  to  curette  if  the  liquid  air  is  applied 
generously  to  the  base  of  the  abscess  after  incision.  No  slough- 
ing follows  except  in  the  case  of  fairly  well  advanced  carbuncles, 
and  in  some  of  the  abscesses,  when  the  overlying  skin  has  be- 
come devitalized  from  tension  and  inflammation."  In  applying 
liquid  air  it  is  better  to  apply  it  intermittently  while  the  operator 
is  working  than  to  try  to  freeze  the  part  so  that  it  will  remain 
senseless  for  any  length  of  time.  This  intermittent  use  of  the 
spray  would  not  be  necessary  when  a  simple  incision  was  required 
as  in  the  case  of  opening  an  abscess.  In  all  such  cases  it  is  ap- 
plied in  the  form  of  spray. 

Dental  Uses. — As  a  local  anaesthetic  to  relieve  the  pain  of  all 
inflammatory  and  ulcerated  conditions,  such  as  periodontitis, 
alveolar  abscess,  ulcers,  pulpitis,  etc.  ;  also  to  abort  periodontitis, 
and  alveolar  abscesses  in  their  incipient  stages ;  also  for  opening 
abscesses,  and  in  the  treatment  of  ulcers. 


LOCAL   AX/ESTHESIA.  271 

Rapid  breathing  as  a  pain  obtunder. — A  method  first  suggested 
bv  the  late  Dr.  VV.  G.  A.  Bonwell,  and  from  which  he  claimed  a 
similar  effect  to  that  of  ether,  chloroform  and  nitrous-oxide  gas 
in  their  primary  stages,  and  to  render  the  patient  sufficiently  un- 
conscious to  any  acute  pain  from  any  operation,  where  the  time 
consumed  is  not  over  from  twenty  to  thirty  seconds.  "  While 
the  special  senses  are  in  partial  action,  the  sense  of  pain  is  ob- 
literated and,  in  many  cases,  completely  annulled,  consciousness 
and  general  sensibility  being  preserved."  "To  accomplish  this, 
each  patient  must  be  instructed  how  to  act  and  what  to  expect. 
As  simple  as  it  may  seem,  there  is  a  proper  and  consistent  plan 
to  enable  you  to  reach  full  success.  Before  the  patient  com- 
mences to  inhale  he  is  informed  of  the  fact  that  while  he  will  be 
unconscious  of  pain,  he  will  know  full  or  partially  well  any 
touch  upon  his  person  ;  that  the  inhalation  must  be  vigorously 
kept  up  during  the  whole  operation,  without  for  an  instant 
stopping ;  that  the  more  energetically  and  steadily  he  breathes, 
the  more  perfect  the  effect.  It  is  obligatory  to  do  so,  on  account 
of  its  evanescent  effects,  which  demand  that  the  patient  be 
pushed  by  the  operator  over  energetic  appeals  to  'go  on.'  It  is 
verv  difficult  for  any  one  to  respire  over  one  hundred  times  to 
the  minute,  as  he  will  become  by  that  time  so  exhausted  as  not 
to  be  able  to  breathe  at  all.  For  the  next  minute  following  the 
completion  of  the  operation,  the  subject  will  not  breathe  more 
than  once  or  twice.  Very  few  have  force  enough  left  to  raise 
hand  or  foot.  The  voluntary  muscles  have  nearly  all  been 
subjugated  and  overcome  by  the  undue  effort  at  forced  inhalation 
of  one  hundred  and  seventeen,  the  normal  standard. 

"  The  heart's  action  is  not  increased  more  than  from  seventy 
(the  average)  to  eighty  and  sometimes  ninety,  but  is  much  en- 
feebled, or  throwing  a  lesser  quantity  of  blood.  The  face  be- 
comes suffused,  as  in  blowing  a  fire  or  in  stooping,  which  con- 
tinues until  the  breathing  is  suspended,  when  the  face  becomes 
paler.  (Have  not  noticed  any  purple,  as  from  asphyxia  by  a 
deprivation  of  oxygen.)  The  vision  becomes  darkened,  and  a 
giddiness  soon  appears.  The  voluntary  muscles  farthest  from  the 
heart  seem  first  to  be  affected,  and  the  feet  and  hands,  particularly 


272  DENTAL  MEDICINE. 


the  latter,  have  a  numbness  at  their  extremities,  which  increases 
until,  in  many  cases,  there  is  partial  paralysis  as  far  as  the  elbow, 
while  the  limbs  become  fixed.  The  hands  are  so  thoroughly  af- 
fected, that  when  open  the  patient  is  powerless  to  close  them, 
and  vice  versa.  There  is  a  vacant  gaze  from  the  eyes,  and  a 
looking  into  space  without  blinking  of  the  eyelids  for  a  minute 
or  more.  The  head  seems  incapable  of  being  held  erect,  and 
there  is  no  movement  of  the  arms  or  legs,  as  is  usual  when  in 
great  pain.  There  is  no  disposition  on  the  part  of  the  patient 
to  take  hold  of  the  operator's  hand  or  interfere  with  the 
operation."  Dr.  Bonwell  based  his  method  on  the  following 
theory  : — 

,  I.  Diversion  of  the  will-force  in  the  act  of  forced  respira- 
tion at  a  moment  when  the  heart  and  lungs  have  been  in  normal 
reciprocal  action  (twenty  respirations  to  eighty  pulsations) ; 
which  act  could  not  be  made  and  carried  up  to  one  hundred 
respirations  per  minute  without  such  concentrated  effort  that 
ordinary  pain  could  make  no  impression  upon  the  brain  while 
this  abstraction  was  kept  up. 

2.  There  is  a  specific  effect  resulting  from  enforced  respira- 
tion of  one  hundred  to  the  minute,  due  to  the  excess  of  carbonic 
acid  gas  set  free  from  the  tissues.^  generated  by  this  enforced  normal 
act  of  throwing  into  the  lungs  five  times  the  normal  amount  of 
oxygen  demanded  in  one  minute,  when  the  heart  has  not  been 
aroused  to  exalted  action,  which  comes  from  violent  action  in 
running,  or  where  one  is  suddenly  startled  ;  which  excess  of  car- 
bonic acid  cannot  escape  in  the  same  ratio  from  the  lungs,  since 
the  heart  does  not  respond  to  the  proportionate  overaction  of  the 
lungs. 

3.  "  Hyperxmia  is  the  last  in  the  chain  of  effects ;  which  is 
due  to  the  excessive  amount  of  air  passing  into  the  lungs,  pre- 
venting but  little  more  than  the  normal  quantity  of  blood  from 
passing  from  the  heart  into  the  arterial  circulation,  but  damming 
it  up  in  the  brain,  as  well  as  throughout  the  capillary  and  venous 
systems  as  well  as  upon  the  heart,  the  same  as  if  it  were  sus- 
pended in  that  gas  outside  the  body." 

Dr.  A.  Hewson  agrees  with  Dr.  Bonwell  as  to  the  efficacy  of 


AIROL.  273 

rapid  breathing  as  a  pain  obtunder,  yet  he  differs  with  him 
as  to  the  theory  or  nature  of  the  changes  in  the  different 
symptoms  brought  about  during  its  progress.  Dr.  Hewson  states : 
"Every  circumstance  would  therefore  seem  to  indicate  that  this 
process  of  inducing  insensibility  to  pain  is  one  essentially  of  di- 
minished oxidization  and  decarbonization  of  the  blood,  and  recog- 
nizing such  a  state  as  belonging  to  the  initiative  stage  of  all  an- 
aesthetics, when  insensibility  to  pain  is  positively  marked,  we  have 
no  necessity  for  begging  any  special  theory  for  this  process,  as  in 
its  action  it  readily  comes  under  the  category  of  such  agents,  and 
is  thus  not  either  an  absurdity  or  an  impossibility  from  a  scien- 
tific point  of  view." 

AIROL, 

Derivation. — Airol  is  a  Gallate  of  Bismuth  Iodide.  It  is  in 
the  form  of  a  grayish-green  powder. 

Medical  Properties  and  Physiological  Action. — The  iodine  is  so 
combined  in  this  preparation  as  to  render  it  an  extremely  active 
antiseptic,  and  deodorizer  and  no  irritating  or  toxic  effects  ensue 
from  its  too  rapid  liberation. 

Therapeutic  Uses. — Locally  applied  it  is  an  efficient  antiseptic 
and  deodorizer  in  ulcerative  and  suppurative  conditions. 

Dental  Uses. — Airol  is  employed  in  the  treatment  of  devitalized 
teeth,  putrid  conditions  of  the  pulp,  its  application  in  the  form  of 
the  dry  powder  causing  a  dessicative  action  as  well  as  antiseptic. 
It  is  also  serviceable  in  chronic  inflammation  of  pulps  of  teeth, 
acting  somewhat  like  pepsin. 

It  should  be  confined  in  the  tooth-cavity  by  a  gutta  percha 
filling,  and  retained  for  one  or  two  days,  when  the  pulp  will  pre- 
sent a  dry,  aseptic  appearance. 

ACTOL— SILVER  LACTATE. 

Formula.— AgC^H,0^=H20. 

Therapeutic  and  Dental    Uses, — Actol  occurs   in  the  form  of  a 

white,  tasteless,  and   inodorous   powder,  soluble  in  water,  and  is 

recommended  as  a  surgical  antiseptic  and  germicide.      It  is  used 

as  a  hypodermic  injection  in  erysipelas  ;  as  a  wash,  a  teaspoonful 

i8 


274  DENTAL  MEDICINE. 


of  the  solution  (1.50)  to  a  glass  of  water.  An  aqueous  solution 
(i.ioo)  will  destroy  all  pathogenic  microbes  within  five  minutes. 

Dr.  Harlan  states  that  he  has  used  actol  in  suppurating  pockets 
on  the  sides  of  roots  of  teeth  with  excellent  results. 

It  will  stain  the  cementum,  but  such  stains  are  as  easily  re- 
moved as  those  from  nitrate  of  silver.  Actol  causes  no  pain 
when  used  as  strong  as  a  twenty  per  cent,  solution. 

ALCOHOL. 

Formula. — CjHjOH.  Sp.  gr.  of  officinal  alcohol,  0.820 ;  of 
rectified  spirit — Spiritus  Rectificatus,  0.838  ;  of  stronger  alcohol 
— Alcohol  Fortius^  0.817;  of  diluted  alcohol — Alcohol  D'llutum 
(equal  parts  of  alcohol  and  distilled  water),  0.928. 

Derivation. — Alcohol  is  obtained  from  vinous  or  fermented 
liquors  by  repeated  distillations,  and,  in  its  oflicinal  form,  contains 
about  fifteen  per  cent,  of  water.  It  is  colorless,  inflammable, 
wholly  vaporizable  by  heat,  and  unites  in  all  proportions  with 
water  and  ether.  It  frequently  contains  such  impurities  as  fusel 
or  amylic  alcohol  (obtained  from  fermented  grain  or  potatoes)  ; 
the  presence  of  which  can  be  detected  by  agitating  the  alcohol 
with  sulphuric  acid,  when  the  former  becomes  colored. 

Stronger  Alcohol. — Alcohol  Fortius — Absolute  Alcohol — is  ob- 
tained by  agitating  the  oflficinal  alcohol  with  heated  carbonate  of 
potassium.     Sp.  gr.,  0.794,  when  containing  no  water. 

Medical  Properties  and  Action. — All  the  different  forms  of  alco- 
hol, including  brandy — Spiritus  Vini  Gallici  (the  spirit  obtained 
from  fermented  grapes  by  distillation,  and  containing  45  to  55 
per  cent.,  by  volume,  of  absolute  alcohol);  whisky — Spiritus 
Frumenti  (the  spirit  obtained  from  fermented  grain  by  distillation, 
and  containing  from  50  to  58  per  cent.,  by  volume,  of  absolute 
alcohol)  ;  wine — Vinum  (the  fermented  juice  of  the  grape,  and 
containing  alcohol  in  varying  proportions)  are  powerful  diffusible 
stimulants,  increasing  the  action  of  the  heart  and  arteries,  excit- 
ing the  nervous  and  vascular  systems,  and  causing  a  general  ex- 
hilaration of  spirits.  Excessive  quantities  produce  the  effect  of 
narcotic  poisons,  ending  in  coma  and  death. 

The  habitual  use  of  alcoholic  drinks  causes  most  injurious  ef- 


ALCOHOL.  275 

fects  upon  the  system  generally  and  directly  upon  the  mucous 
coats  of  the  stomach,  deranging  and  destroying  its  functions  and 
structure,  resulting  in  dyspepsia,  followed  by  cirrhosis  of  the  liver 
and  kidneys,  loss  of  mental  and  physical  strength,  derangement 
of  the  nervous  system,  and  at  last,  delirium  tremens.  When 
properly  administered  in  diseased  conditions,  however,  alcoholic 
preparations  are  valuable  agents. 

Therapeutic  Uses. — The  different  forms  of  alcohol  are  em- 
ployed as  stimulants  in  acute  inflammations,  such  as  pneumonia, 
pleurisy,  bronchitis,  pulmonary  affections  of  children,  etc.,  etc., 
and  in  rheumatic  pericarditis,  in  the  latter  stages  of  typhus  and 
typhoid  fevers,  diphtheria,  acute  neuralgia,  convulsions  of  denti- 
tion, tetanus,  asphyxia  from  cold,  pyemia,  etc.,  etc.  Externally 
in  superficial  inflammation,  bruises,  sprains,  ptyalism,  gout,  cere- 
bral affections,  bed  sores,  etc.,  etc.  According  to  Bartholow,  al- 
cohol is  an  excellent  hemostatic  for  restraining  oozing  from  a 
large  surface,  and  an  efficient  antiseptic  dressing,  as  it  destroys 
germs,  removes  fetor,  and  stimulates  the  tissues  to  more  healthy 
growth. 

Dental  Uses. — Alcohol,  as  a  narcotic,  is  employed  to  relieve 
pain.  In  combination  with  tannic  acid  or  chloride  of  zinc,  it  ob- 
tunds  the  sensibility  of  dentine ;  as  a  styptic,  it  arrests  hem- 
orrhage from  relaxed  tissues,  coagulating  the  blood  by  its  effect 
on  albumen,  and  causing  contraction  of  the  mouths  of  the  vessels 
by  its  astringent  property.  Equal  parts  of  alcohol  and  water 
make  an  excellent  application  as  an  evaporating  lotion,  for  the  re- 
lief of  superficial  inflammations,  its  antiseptic  properties  render- 
ing it  useful  as  a  mouth-wash  when  the  secretions  are  vitiated 
and  the  surfaces  of  the  mucous  membrane  soft  and  spongy.  It 
is  also  useful  for  cleaning  pulp  canals  as  a  preparatory  treatment 
to  the  use  of  the  more  active  antiseptic  agents,  such  as  the  bi- 
chloride of  mercury.  For  suppurating  wounds,  it  is  a  useful  anti- 
septic dressing,  as  it  destroys  germs,  removes  fetor,  and  stimulates 
the  tissues  to  a  more  healthy  action.  It  also  favors  the  cicatriza- 
tion of  open  wounds,  coagulating  the  albumen,  and  forming  an 
impermeable  covering.  In  mercurial  salivation  (mercurial  stom- 
atitis), it  forms  an  excellent  gargle. 


276 


DENTAL  MEDICINE. 


For  softened  and  sensitive  dentine,  and  for  drying  cavities  pre- 
paratory to  filling  them,  the  stronger  or  absolute  alcohol  is  em- 
ployed. The  spray  of  absolute  alcohol  is  employed  as  a  local 
anaesthetic,  and  is  applied  in  the  same  manner  as  the  spray  of 
rhigolene.  A  simple  method  of  preparing  this  form  of  alcohol 
is  to  add  one  part  of  carbonate  of  potassa  to  four  parts  of  the 
ordinary  or  officinal  alcohol.  Owing  to  the  great  affinity  car- 
bonate of  potassa  has  for  water,  it  abstracts  the  latter  from  the 
alcohol  to  a  sufficient  degree  to  answer  all  practical  purposes. 

The  cavity  of  a  tooth  is  first  dried  with  cotton  and  bibulous 
paper,  and  then  bathed  with  the  absolute  alcohol,  which  at  once 
evaporates,  and  causes  the  almost  perfect  absorption  of  moisture. 

Brandy  and  water  form,  in  combination,  an  excellent  lotion 
for  mercurial  and  other  forms  of  stomatitis. 


DENTAL    FORMUL-i^. 


For  Obtunding  Sensitive  Dentine, 
R.     Alcoholis  (absolute)  .    .  §ss 

Acidi  tannic! Jss 

Glycerini ^ss.    M. 

For  Superficial  Infiammations. 
li .     Alcoholis 

Aquae aa^ss.    M. 

SiGNA, — To  be  applied  as  a  lotion. 

For  Obtunding  Sensitive  Dentine. 
R.     Alcoholis  (absolute)  .    .  ^ss 

Zinci  chloridi ^ss 

Glycerini ^ss.    M. 


For  Mercurial  Stomatitis. 
R .     Spts.  vini  gallici  .    .  i  part 

Aquae  .    .    .    .  4  to  6  parts. 
SiGNA. — To  be  used  as  a  gargle. 


M. 


Antiseptic  Bath  for  Instruments. 
Dr.  a.  W.  Harlan. 

R .     Alcoholis      ^  ij 

Hydronaphthol  .    .    .  grs.  xx.  M. 
Will  not  tarnish  instruments  which 
are  dipped  in  it  and  allowed  to  dry. 


Local  AncEsthetic. 
Dr.  a.  W.  Harlan. 

R.  Alcoholis s  parts 

Tinct.  Cannabis  indica  2  parts 
Olieum    cassise  .    .    .  i  part 
Acidi  carbolici  ...  3  parts,     M. 

SiGNA. — For    injection,  or   on   cotton 
rope  around  tooth. 


Antiseptic  Mouth  Wash. 

Gallipe  and  Malassez. 

R ,     Alcohol 370  parts 

Carbolic  Acid   .    .     10  parts 

Thymol 5  parts 

Oil  of  peppermint  .     15  parts 
Tincture  of  arnica  icx3  parts.  M. 

This  may  be  colored  with  tincture  of 
cochineal. 

SiGNA. — Use  twice  a  day  and  at  same 
time  rinse  out  the  mouth  with  a 
weak  solution  of  boric  acid. 


ALOES. 


27T 


For  Pain  After  Extraction  of  Teeth. 

Dr.  T.  B.  Welch. 
R.     Alcohol  (best)  .    .    .    .   |i 
Chloroform   .    .   '.    .    .  ^  ij 
Sulphuric    ether   ...  3 1^ 
Gum  Camphor  .    .    .    .  ^ss 
Tinct.    opium   .    .    .    .  3J 

Oil  cloves 3SS 

SiGNA. — Apply    in    the    cavity    on    a 
pledget  of  cotton. 

For  Odontalgia. 
Dr.  J.  N.  Harris. 


R. 


Alcoholis  (best)  . 
Chloroformi  .  .  . 
Etheris  Sulph  .  . 
Camphorse  (gum) 
Tinct.  opii  .  .  . 
Oleum  caryophilli 


l\ 


Jss 


SiGNA. — Apply  to  cavity,  and  soon  as 
pain  ceases  fill  the  cavity  with  cot- 
ton moistened  with  carbolic  acid  and 
oil  of  cloves ;  drop  on  this  cotton 
sandarach  varnish,  and  allow  it  to 
remain  20  or  30  minutes. 

Local  AncEsthetic. 
Dr.  I.  Alberto  del  Solar. 
R.     Alcoholis  (98  per  cent.)  f  Jij 

Chloroformi ^5^^ 

Ether,  sulph f  ^  iss 

Camphorae 3J.    M. 

SiGNA. — Apply  to  the  gum  i  minute 
bucally  and  lingually,  first  carefully 
drying  the  surface.  Not  to  be  used 
hypodermically. 


ALOE— ALOES. 

Source. — Aloes  is  the  inspissated  juice  of  the  leaves  of  the  Jloe 
Socotrina^  and  contains  a  bitter  precipitate  known  as  alo'tn.^  and 
also  a  volatile  oil,  to  which  its  odor  is  due.  Its  preparations  are 
purified  aloes — aloe  purificata  ;  watery  Extract  of  Aloes — Ex- 
tractu?n  Aloes  Aquosum  ;  Tincture  of  Aloes — Tinctura  Aloes  \  also 
a  number  of  pilular  forms,  and  a  tincture  combined  with  myrrh 
— Tinctura  Aloes  et  Myrrhae,  and  wine  of  aloes — Vinum  Aloes. 
Purified  Aloes  is  in  the  form  of  pieces  of  a  dull  or  reddish- 
brown  color,  very  brittle  and  soluble  in  alcohol,  and  a  very  bitter 
and  disagreeable  taste. 

Medical  Properties  and  Physiological  Action. — Aloes  is  a  stomachic 
tonic  and  purgative,  being  principally  employed  for  the  latter  ef- 
fect. In  large  doses  its  action  is  that  of  a  powerful  purgative, 
and  hence  it  is  contraindicated  in  irritable  or  inflammatory  con- 
ditions of  the  stomach.  It  stimulates  the  functions  of  the  liver, 
and  increases  the  flow  of  bile  as  well  as  the  intestinal  secretions 
generally.  Its  chief  effects  are  on  the  large  intestine,  increasing 
its  peristaltic  movement,  and  causing  tormina  and  tenesmus  with 
heat  and  irritation  of  the  rectum.  It  also  increases  the  menstrual 
flow  and  the  blood  supply  of  the  pelvic  organs.  It  requires  some 
ten  or  twelve  hours  to  produce  its  cathartic  effects.     A  purgative 


278  DENTAL  MEDICINE. 


action  may  be  induced  by  applying  it  to  an  exposed  surface.  In 
moderate  laxative  doses  the  stools  are  not  liquid  and  but  slightly 
altered  in  character.  It  is  commonly  administered  in  small  doses 
in  combination  with  nux  vomica. 

Therapeutic  Uses. — Aloes  is  very  efficient  in  constipation  de- 
pendent on  weakness  of  the  muscular  layer  of  the  large  intestine. 
It  is  also  employed  in  jaundice,  atonic  dyspepsia,  hemorrhoids 
without  active  pelvic  congestion,  amenorrhoea  dependent  upon 
anaemia,  menorrhagia  in  debilitated  conditions,  gonorrhoea,  ca- 
tarrh of  uterus,  etc. 

Dose. — Of  Aloe  purificata^  gr.  j  to  v ;  Extractum  aloes  aquosum 
gr.  ss  to  iij  ;  Tinctura  Aloes,  foss  to  ij  ;  Tinctura  Aloes  Myrrhae, 
5ss  to  5ij  >   Vinum  Aloes  5j  to  5ss. 

ALUMEN— ALUM. 

Formula. — Common  potash  alum  :  Al2(S04)3,  K2SO424H2O. 
Ammonium  Alum  :   Al2(N  11^)2(804)4,  24H2O. 

Source. — It  is  found  native  in  Italy,  in  the  neighborhood  of 
volcanoes,  and  is  the  mineral  from  which  the  metal  aluminum  is 
obtained. 

Derivation. — Alum  is  also  obtained  from  aluminous  slate, 
shale  or  schist,  by  the  process  of  roasting  and  exposure  to  the 
air. 

Alum  is  a  white,  slightly  efflorescent  salt,  which  crystallizes  in 
regular  octahedrons.  It  possesses  an  astringent,  acid,  and  sweet- 
ish taste.  It  is  insoluble  in  alcohol,  but  dissolves  in  from  four- 
teen to  fifteen  times  its  weight  in  cold,  and  three-fourths  of  its 
weight  in  boiling  water. 

Medical  Properties  and  Action. — Alum  is  astringent  and  styptic, 
and  is  employed  both  externally  and  internally.  When  taken 
internally,  it  is  absorbed  into  the  system,  and  has  been  detected 
in  the  liver,  spleen  and  urine.  Excessive  doses  cause  vomiting, 
griping,  purging,  and  inflammation  of  the  gastro-enteric  mucous 
membrane.  Powdered  alum,  in  doses  of  a  teaspoonful,  is  an 
efficient  emetic.  It  coagulates  albumen  and  causes  an  abundant 
flow  of  saliva,  coagulating  the  albumen  of  the  saliva  and  buccal 
mucus  in  whitish,  membranous  flakes. 


ALUM.  279 

Its  astringent  influence  is  chiefly  upon  mucous  surfaces. 
Applied  locally  to  relaxed  or  bleeding  parts,  it  corrugates  the 
surrounding  tissues  and  causes  contraction  of  the  capillaries,  and, 
in  this  manner,  acts  as  an  astringent. 

Therapeutic  Uses. — Alum  is  internally  administered  in  diar- 
rhoea, chronic  dysentery,  colica  pictonum,  catarrh  of  the 
stomach,  etc.  Externally  it  is  applied  in  ulcerated  and  relaxed 
throat  affections,  ptyalism,  gonorrhoea  and  gleet,  uterine  hem- 
orrhage, morbid  growths,  hematuria,  ophthalmia,  chronic 
whooping-cough,  chronic  skin  diseases,  chilblains,  ulcers, 
hospital  gangrene,  etc.,  etc. 

Dose. — Of  alum,  gr.  x  to  I3j  or  3ij,  in  powder,  or  solution  in 
water,  or  in  some  simple  infusion. 

Ammonia  Alum. — Sulphate  of  alumina  and  ammonia — 
Alumincs  et  Ammonite  Sulphas — is  prepared  by  adding  sulphate  of 
ammonia  to  a  solution  of  sulphate  of  alumina. 

Dried  Alum. — Alumen  Exsiccatum  (alum  deprived  of  its 
water  of  crystallization  by  heat)^ — is  employed  externally  as  a 
mild  escharotic,  to  destroy  exuberant  granulations,  etc. 

Dental  Uses. — Alum  is  employed  in  dental  practice  as  a  styptic 
in  alveolar  hemorrhage ;  as  a  gargle  in  stomatitis,  ulceration, 
and  sponginess  of  the  gums,  morbid  or  fungous  growth  of  gums, 
dental  pulp,  etc.,  superficial  hemorrhage  from  the  mucous 
membrane  of  the  mouth,  ulcers  of  the  mouth,  cancrum  oris, 
odontalgia,  after  the  extraction  of  teeth — one  drachm  in  a  tumbler 
of  water,  etc.,  etc.  In  congested  conditions  of  the  mucous 
membrane  of  the  mouth  and  throat,  alum  gargles  afford  great 
relief.  Powdered  alum  added  to  liquor  sodae  chlorinatas 
(Labarraque's  Solution),  is  an  excellent  bleaching  application 
for  discolored  necrosed  teeth. 

The  habitual  use  of  alum  as  an  ingredient  of  a  dentifrice  is 
injurious  to  the  teeth,  on  account  of  the  sulphuric  acid  it 
contains. 

Potash  alum — Aluminii  et  Potassii  Sulphas — the  alum  of 
commerce  (which  has  been  superseded  by  ammonia  alum),  will 
render  plaster  casts  hard,  when  they  are  boiled  in  a  strong 
solution  for  half  an  hour. 


280  DENTAL  MEDICINE. 


DENTAL    FORMUL/E. 
For  Odontalgia.  For     Ulceration    of   the     Gums    and 

R.     Pulveris  aluminis  .  .    ^ij  Mucous  Membrane  of  the  Mouth. 

iEtheris  nitrici  .  .  .  .  ^vij  R-     Aluminis 3J 

SiGNA.  —To  be  applied  on  a  pellet  of  Zinci  sulphatis  ...    3  ss 

cotton.  Sodii  borat gr.  iv 

Aquae  rosse ^viij.      M. 

For   Inflamed  and  Ulcerated  Mucous      SiGNA.— To  be  applied  as  a  lotion. 
Membrane  and  Gums.  For  Ulcerated  and  Spongy  Gums. 

R.     Aluminis ^j 

R ,     Pulveris  aluminis  .  .  gr.lxxx  Vini Oj 

Aquae  destillatae  .  .     f  J  x.        M.  Tinct.  cinchonae  .  .  .  ^  ss 

SiGNA. — To  be  applied  as  a  mild  as-  Tinct.  myrrhae  ...    ^ij 

tringent  gargle.  Mel.  rosae ^  ij.         M. 

SiGNA. — To  be  used  as  a  gargle. 

For  Inflammation  and  Ulceration  of  the  Mouth  and  Throat. 

R .         Infus  lini J  xv 

Tinct.  kino ^j 

Aluminis gu*  M. 

SiGNA. — To  be  applied  as  a  gargle. 

ALUMINA  ACETAS— ACETATE  OF  ALUMINA. 

Formula.— k\lOYi)lQ.]A^O^,. 

Derivation. — The  salt,  Acetate  of  Alumina,  is  obtained  by 
the  direct  combination  of  hydrated  alumina  with  acetic  acid,  or 
by  reaction  between  sulphate  of  alumina  and  acetate  of  lead. 
The  solution,  when  properly  prepared,  is  a  clear  fluid,  of  a 
sharp,  sweetish,  astringent  taste,  and  a  distinct  odor  of  acetic 
acid.  When  it  is  evaporated,  there  is  deposited  light,  fragile, 
glossy  scales,  which  are  perfectly  soluble  in  water,  and  not 
readily  affected  by  the  atmosphere. 

Medical  Properties  and  Action. — It  is  disinfectant  and  anti- 
septic. In  maximum  doses  it  produces  an  unpleasant  sensation 
of  warmth  and  fullness  in  the  stomach,  and  at  the  same  time, 
vertigo  and  confusion  of  the  senses,  which  may  continue  for 
several  hours. 

Therapeutic  Uses. — Acetate  of  alumina  is  rarely  employed 
internally,  and  only  for  zymotic  and  contagious  diseases.  It  is 
generally  used  externally,  and  is  a  very  effectual  remedy  in  the 
treatment  of  wounds,  preventing  pvemia  in  suppurating  wounds 
and   ulcers.      It  is  also  applied  in  parasitic  skin  affections,  as  an 


AMMONIA.  281 


injection  in  gonorrhoea,  and  for  the  destruction  of  animalculae  in 
putrescent  fluids.  As  a  surgical  dressing,  it  is  used  by  keeping 
the  wound  saturated  with  a  solution  of  moderate  strength,  or  by 
irrigation.  A  concentrated  solution  will  preserve  anatomical 
subjects  for  a  considerable  time. 

Dose. — Of  acetate  of  alumina,  gtt.  xx  to  gtt.  60  of  the 
solution. 

Dental  Uses. — Acetate  of  alumina  is  useful  in  dental  practice, 
as  an  antiseptic  and  disinfectant  in  cancrum  oris,  ulcers  of  the 
mouth,  suppurating  wounds  of  mucous  membrane,  pyorrhoea 
alveolaris,  alveolar  abscess,  etc.  A  very  weak  solution  has  been 
employed  as  a  mouth-wash  for  offensive  breath  depending  on 
scrofulous  ulcerations,  aphthae,  caries  of  the  teeth,  or  the  wearing 
of  artificial  teeth. 

AMMONIUM— AMMONIA. 

Formula. — NH^. 

Ammonia,  often  called  ammoniacal,  or  ammonia  gas,  is 
colorless  and  readily  soluble  in  water,  and  forms  a  number  of 
volatile  stimulants,  such  as  Aqua  ammonia — ammonia  water, 
which  is  the  stronger  water  of  ammonia  diluted  with  two  parts 
of  water;  Aqua  ammonice  fortior — stronger  water  of  ammonia, 
is  made  by  passing  ammonia  gas  into  water  to  make  its  specific 
gravity,  0.900  at  59°  F. ;  Spiritus  ammonice — which  is  a  ten  per 
cent,  solution  of  ammonia  gas  in  alcohol ;  Spiritus  ammonice 
aromaticus^  which  is  an  alcoholic,  or  rectified  spirit,  solution  of 
carbonate  of  ammonium,  to  which  are  added  oils  of  lemon, 
nutmeg  and  lavender.  (See  also  muriate  of  ammonia,  sal 
ammoniac,  carbonate  of  ammonium,  solution  of  acetate  of 
ammonia,  spirit  of  mindererus,  chloride  of  ammonium,  and 
valerianate  of  ammonium.) 

Medical  Properties  and  Physiological  Action. — Ammonia  gas  is 
very  alkaline,  and  an  irritant  to  mucous  surfaces.  Inhaled,  it 
causes  an  overpowering  sense  of  suffocation  and  spasm  of  the 
glottis,  and  when  prolonged,  violent  inflammation  of  the  air- 
passages.  Solution  of  ammonia  when  swallowed  causes  destruc- 
tive inflammation  of  the  mucous  membrane,  extending  to  the 
stomach.     The  long-continued   use  of  ammonia  interferes  with 


282  DENTAL  MEDICINE. 


digestion  by  neutralizing  the  gastric  juice,  and  by  increased 
waste  of  tissue  causes  pallor,  emaciation,  and  feebleness.  In  the 
blood  it  injures  the  red  blood  globules,  and  thus  affects  the 
nutrition  of  the  body,  being  largely  converted  into  urea.  The 
preparations  of  ammonia  are  stimulant  expectorants. 

Therapeutic  Uses. — Aqua  ammonia  is  administered  by  inhala- 
tion in  syncope  and  shock,  and  as  a  counter-irritant ;  for  which 
purpose  ammonia  liniment  is  also  employed.  The  incautious 
inhalation  of  ammonia  may  cause  inflammation  of  the  fauces  and 
glottis,  but  when  cautiously  employed  sometimes  gives  relief  to 
acute  catarrh  and  hay  asthma.  The  diluted  aqua  ammonia  will 
relieve  the  pain  of  stings  of  insects,  and  the  strong  aqua  am- 
monia is  an  antidote,  when  at  once  applied,  to  the  bite  of  ven- 
omous snakes,  and  of  rabid  animals.  The  aromatic  spirits  of 
ammonia  is  useful  in  acidity  of  stomach,  gaseous  eructations  and 
abdominal  distensions  ;  also  in  sick  headache  and  migraine  ;  but 
the  bromides  are  more  effective  in  the  latter  affection.  Ammonia 
salts  stimulate  the  liver  and  increase  the  secretions  of  the  kidneys 
and  intestinal  mucous  glands  and  the  action  of  the  heart,  hence 
are  frequently  used  in  adynamic  states,  constipation,  coated 
tongue  and  scanty  urine.  The  preparations  of  ammonia  for 
internal  use  correct  obstinate  vomiting  when  the  irritating  sub- 
stances are  removed,  and  the  matters  vomited  are  acid. 

Dose. — Of  Aqua  Ammoniac,  TUv  to  oss,  much  diluted;  of 
Spiritus  Ammonias,  lUx  to  f  oj,  greatly  diluted ;  of  Spiritus  Am- 
moniac Aromaticus,  foss  to  fo'j- 

Dental  Uses. — Ammonia  is  used  as  a  stimulant  in  dangerous 
narcosis;  to  prevent  syncope  or  severe  shock;  in  facial  neuralgia, 
especially  the  chloride,  and  in  periodontitis  when  it  is  combined 
with  aconite  and  opium.  Aqua  ammonia  is  locally  applied  as  a 
counter-irritant  to  the  gums  in  acute  inflammation  of  the  peri- 
dental membrane.  (See  Acetate,  Carbonate,  Valerianate  and 
Chloride  of  Ammonium.) 

Aromatic  Spirits  of  Ammonia^  or  Sal  Volatile,  is  one  of  the  most 
diffusible  stimulants  and  is  antacid  and  carminative.  It  is  em- 
ployed for  syncope  resulting  from  shock,  dental  operations,  etc., 
and  acts  as  a  stimulant  where  alcohol  is  contraindicated.     As 


SOLUTION   OF   ACETATE    OF   AMMONI.  283 


an  antacid  is  serviceable  in  acid  conditions  of  the  oral  fluid,  in 
superficial  caries  of  the  teeth,  erosions,  and  sensitive  necks  of 
teeth, 

LIQUOR  AMMONII  ACETATIS— SOLUTION  OF  ACETATE  OF 
AMMONIA. 

SPIRIT    OF    MINDERERUS. 

Formula.— NH^C,H.,0.,. 

Derivation. — Spirit  of  Mindererus  is  obtained  by  saturating 
diluted  acetic  acid  with  carbonate  of  ammonia,  being  a  solution 
of  the  acetate  of  ammonia. 

It  is  a  colorless  liquid,  with  a  saline  taste,  and  requires  to  be 
freshly  made  when  about  to  be  used. 

Medical  Properties  and  Action. — It  is  refrigerant,  diaphoretic, 
and  diuretic,  and  its  action  can  be  greatly  increased  by  combina- 
tion with  other  remedies.  Few  medicines  are  in  more  general 
use. 

Therapeutic  Uses. — Spirit  of  mindererus  is  employed  in  the 
treatment  of  febrile  and  inflammatory  affections,  and  exanthe- 
mata, sick  headache,  catarrh  and  influenza,  etc.,  etc.  Exter- 
nally it  is  used  as  a  lotion  to  sprains,  bruises,  glandular  enlarge- 
ments, etc. 

Dose. — Of  spirit  of  mindererus,  f5j  to  f.3J. 

Dental  Uses. — A  lotion  composed  of  one  part  to  ten  of  water 
is  a  serviceable  application  in  inflamed  conditions  of  mucous 
membrane.  Internally  administered  as  a  refrigerant  it  is  useful 
in  acute  periosteal  inflammation,  inflammation  of  the  dental  pulp 
— pulpitis,  and  is  a  diaphoretic  and  refrigerant  in  periodontitis, 
when  it  may  be  combined  with  either  aconite  or  opium,  or  both. 

AMMONII  CARBONAS— CARBONATE  OF  AMMONIUM. 

/bm«A7.— NH.HCOg,  NH,NH2C02. 

Derivation. — Carbonate  of  Ammonium  is  a  sesquicarbonate, 
and  is  obtained  by  subliming  a  mixture  of  chloride  of  ammonium 
and  chalk.  It  is  in  the  form  of  white,  translucent  masses,  with 
a  pungent  ammoniacal  odor,  and  an  acrid,  alkaline  taste.  It  is 
soluble  in  water,  and  on  exposure  to  the  air  it  becomes  opaque 
and  falls  into  powder,  losing  its  ammonia. 


284  DENTAL  MEDICINE. 


Medical  Properties  and  Jetton. — It  is  antacid,  stimulant,  dia- 
phoretic and  expectorant,  and  it  is  considered  to  be  especially 
useful  in  cases  where  the  vital  powers  are  greatly  depressed.  In 
large  doses  it  causes  colic,  convulsions  and  great  disturbance  of 
the  nervous  system,  and  when  long  continued,  an  annoying  itch- 
ing of  the  scalp,  and  skin  over  the  surface  of  the  body.  It  has 
a  tendency  to  fluidify  the  blood.  Internally,  as  a  (diffusible  stim- 
ulant, it  is  preferred  to  solution  of  ammonia. 

Therapeutic  Uses. — It  is  internally  administered  in  diabetes, 
scrofula  with  languid  circulation,  asthma,  pneumonia,  croup, 
chorea,  diseases  of  the  skin,  puerperal  insanity,  mercurial 
erethism,  drunkenness,  etc.,  etc. 

Externally  it  is  employed  as  a  volatile  or  smelling  salts,  in 
syncope,  hysteria,  and  asphyxia. 

Dose. — Of  carbonate  of  ammonium,  gr.  v  to  gr.  x,  in  pill  or 
in  solution  with  gum  and  sugar. 

Dental  Uses. — It  is  a  useful  internal  remedy  in  cancrum  oris, 
in  doses  of  gr.  v,  gradually  increased  to  gr.  x,  every  two  or  three 
hours,  using  strong  nitric  acid  as  a  local  application.  It  is  also 
a  very  useful  remedy  in  mercurial  erethism,  in  conjunction  with 
camphor  and  other  stimulants ;  also  as  a  stimulant  in  dangerous 
narcosis  from  anaesthetic  agents. 

AMMONII  CHLORIDUM— CHLORIDE  OF  AMMONIUM. 

MURIATE     OF     AMMONIA HYDROCHLORATE     OF     AMMONIA SAL 

AMMONIAC. 

Formula.— 1<SH,C\. 

Derivation. — Chloride  of  Ammonium  is  obtained  by  neutraliz- 
ing hydrochloric  acid  with  ammonia  and  evaporating  to  dryness. 
It  is  in  the  form  of  a  snow-white,  crystalline  powder,  soluble 
in  two  and  a  half  parts  of  cold  water,  and  sparingly  soluble  in 
alcohol.     It  has  a  pungent,  saline  taste. 

Medical  Properties  and  Action. — In  large  doses  it  is  an  irritant 
poison,  with  a  purging  action  ;  but  in  small  doses  it  is  a  power- 
ful resolvent  alterative;  it  is  also  refrigerant  and  anodyne.  Its 
action  upon  the  system  closely  resembles  that  of  mercury  as  an 
alterative. 


AMYLENE.  '  285 


Externally  it  is  used  as  a  discutient  application,  and  as  a  cold 
lotion  in  fevers,  hernia,  etc. 

Therapeutic  Uses. — It  is  employed  internally  in  amenorrhcea, 
rheumatic  affections,  chronic  bronchitis,  pneumonia,  dropsical 
affections,  hemorrhages,  whooping-cough  and  myalgia.  Exter- 
nally in  abscesses  of  the  mamma,  skin  diseases,  ecchymosis  of 
the  eye,  hydrocele,  senile  gangrene,  gonorrhoea,  leucorrhcea,  etc. 

Dose. — Of  chloride  of  ammonium,  gr.  v-xxx,  every  two  or 
three  hours,  in  powder  or  mucilage. 

Dental  Uses. — It  is  employed  in  facial  neuralgia,  in  doses  of 
5ss,  repeated  four  times  daily.  Externally  it  is  used  as  an  appli- 
cation to  indolent  ulcers,  for  its  stimulating  effect.  .As  a  gargle, 
it  is  employed  in  the  strength  of  5ss  to  5xij  of  water.  It  is  also 
applied  to  cancerous  tumors,  and  has  been  used  to  restore  zinc 
which  has  become  deteriorated  from  long  use  in  laboratory  work. 
Chloride  of  ammonium  (sal  ammoniac)  is  also  used  as  a  flux,  in 
refining  gold  for  laboratory  use. 

AMYLENE. 

Formula. — C5H1Q. 

Derivation. — Amylene  is  obtained  by  distilling  amylic  alcohol 
with  chloride  of  zinc.  It  is  a  colorless,  very  mobile  liquid,  with 
a  boiling  point  of  102°,  and  the  density  of  its  vapor  2.45.  It 
has  a  very  peculiar  and  disagreeable  smell. 

Medical  Properties  and  Physiological  Action. — Amylene  was  in- 
troduced as  an  anaesthetic  in  1856,  by  the  late  Dr.  Snow,  who 
regarded  it  as  possessing  the  following  advantages:  the  safety  of 
ether,  absence  of  pungency  and  irritating  property,  readiness 
with  which  the  absense  of  pain  is  obtained,  with  less  coma  than 
with  chloroform  or  ether,  the  speedy  recovery  from  its  effects, 
less  nauseating,  and  less  headache  and  rigidity  and  struggling 
than  in  the  case  of  ether  or  chloroform.  Others,  however, 
have  not  been  so  much  impressed  with  this  anaesthetic  agent  as 
was  Dr.  Snow  ;  hence,  it  has  not  been  regarded  with  the  same 
favor  as  other  agents  of  this  class.  An  extreme  quantity  being 
required  to  produce  complete  insensibility  to  pain,  its  operation 
is  considered  to  be  dangerous. 


286  DENTAL  MEDICINE. 


Therapeutic  Use. — As  an  anaesthetic. 

Hydrate  of  Amylene  is  a  tertiary  alcohol  first  prepared  by 
Wurtz.  It  is  a  colorless,  watery-looking  fluid,  with  a  sharp 
taste  and  smell,  and  is  soluble  in  eight  times  its  volume  of  al- 
cohol. It  is  generally  regarded  as  a  safe  and  reliable  narcotic 
and  hypnotic,  sleep  being  produced  in  from  fifteen  to  forty- 
five  minutes,  and  sometimes  almost  instantly.  When  large 
doses  are  given,  sleep  may  be  induced  in  five  or  eight  minutes, 
and  as  a  rule  its  actions  are  prompt  and  safe.  Contraindi- 
cations of  the  drug  have  not  yet  been  observed,  but  in  cases 
of  severe  gastric  troubles  and  ulcerations  of  the  pharynx,  it  should 
be  given  per  anus.  Its  action  may  be  briefly  summed  up  as 
follows  : 

1.  Hydrate  of  amylene  is  a  hypnotic  whose  action  can  be 
confidently  relied  upon  when  sufficiently  large  doses  are  given. 
Experiments  have  shown  that  it  is  not  so  strong  as  chloral,  yet 
stronger  than  paraldehyde. 

2.  Hydrate  of  amylene  also  acts  upon  persons  who  are  ac- 
customed to  the  use  of  hypnotics,  although  the  dose  employed  in 
such  cases  must  be  comparatively  large. 

3.  Sleep  occurs  soon  after  the  administration  of  the  drug, 
and  is  not  preceded  by  any  period  of  excitement.  The  sleep 
produced  is  light  or  heavy,  according  to  the  dose  given  ;  yet  it  is 
always  easy  to  awaken  the  patient.  Upon  waking,  the  patient  is 
perfectly  sensible  and  bright,  but  if  not  disturbed  further  will  fall 
asleep  again. 

4.  Sleep  lasts  from  two  to  three  hours  if  small  doses  have 
been  given,  or  from  six  to  eight  hours  under  the  influence  of 
larger  doses. 

5.  The  awaking  is  similar  to  that  from  natural  sleep.  The 
patient  feels  rested  and  strengthened.  No  headache  or  weakness 
was  ever  observed. 

6.  The  respiration  remains  unchanged. 

7.  The  change  in  the  pulse's  frequency  and  in  the  press- 
ure of  blood  is  no  more  than  that  which  accompanies  natural 
sleep. 

8.  The  patients  were  never  observed  to  wake  up  with  a  bad 


NITRITE   OF   AMYL.  287 


taste  in  their  mouths  and  complaining  of  a  disagreeable 
smell,  symptoms  which  nearly  always  follow  the  use  of  paral- 
dehyde. 

9.  Whether  or  ndt  a  habit  and  tolerance  for  the  drug  may 
be  formed  remains  yet  to  be  seen.  As  yet,  even  when  the  dose 
has  been  used  continually,  an  increase  of  dose  was  never  found 
necessary. 

Dose. — Of  hydrate  of  amylene,  grs.  xii  to  grs.  xxxvii.  It  may 
be  administered  in  gelatin  capsules  containing  15^  grains  each, 
or  in  the  fluid  form  mixed  with  claret  and  water,  or  raspberry 
syrup. 

AMYL  NITRIS— NITRITE  OF  AMYL. 

Formula. — CgHnNOj.     Sp.  gr.,  0.877. 

Derivation. — Nitrite  of  Amyl  is  prepared  by  the  action  of 
nitric  acid  on  amylic  alcohol  (fusel  oil).  The  distilled  portion  ob- 
tained below  212°  F.  is  rectified  by  means  of  carbonate  of  potas- 
sium, and  that  portion  only  distilling  between  200°  and  206°  F. 
is  reserved,  being  a  nitrite  of  oxide  of  amyl.  It  is  a  yellowish  or 
amber-colored  liquid,  somewhat  oily,  very  volatile  and  inflam- 
mable, and  boils  at  182°  F.  It  has  an  odor  like  that  of  ripe 
pears,  and  belongs  to  the  class  of  compound  ethers. 

Medical  Properties  and  Physiological  Action. — It  is  used  by  inhala- 
tion, causing  an  accelerated  action  of  the  heart,  sudden  flushing  of 
the  face,  dilatation  of  the  arteries,  paralysis  of  the  action  of  the 
smaller  arteries,  a  sense  of  great  fullness  of  the  brain,  a  lowering  of 
the  blood-pressure  and  temperature,  and  complete  resolution  of  the 
muscular  system.  The  vapor  of  nitrite  of  amyl,  when  applied 
directly  to  the  muscular  or  nervous  tissues,  arrests  their  functional 
activity,  and,  circulating  in  the  blood,  appears  to  act  most  on  the 
vaso-motor  system  and  unstriped  muscular  fibre.  It  affects 
respiration  and  the  composition  of  the  blood,  producing  head- 
ache, which  is  often  prolonged. 

Therapeutic  Uses. — Being  a  powerful  stimulant  to  the  heart, 
it  is  an  antidote  to  chloroform  and  cocaine.  A  case  is  mentioned 
in  the  British  Medical  'Journal^  where,  during  chloroform  narcosis, 
respiration  ceased,  and  artificial  respiration   failed  to  restore  the 


288  DENTAL  MEDICINE. 


patient.  Some  nitrite  of  amyl  was  then  poured  on  lint,  and  held 
to  the  patient's  nostrils.  In  ten  seconds  there  was  a  flushing  of 
the  face,  the  pulse  was  again  felt,  and  respiration  was  restored. 

When  from  two  to  five  minims  are  poured  on  lint  and  applied 
to  the  nostrils,  the  heart's  action  will  be  accelerated,  a  sudden 
flushing  of  the  face  takes  place,  dilatation  of  the  arteries  results, 
also  a  fall  in  the  blood  pressure  and  a  lowering  of  the  temperature, 
and  complete  muscular  relaxation.  As  a  remedy  for  chloroform 
narcosis,  it  is  supposed  to  antagonize  cerebral  anemia  by  causing 
capillary  dilatation  and  thus  promoting  the  inflow  of  blood  to  the 
brain. 

By  inhalation,  for  relieving  the  pain  of  angina  pectoris,  and 
preventing  epileptic  seizures;  also  used  in  asthma,  strychnia 
poisoning,  hydrophobia,  tetanus,  epileptic  attacks,  and  in  many 
other  convulsive  or  spasmodic  diseases. 

Dose. — Of  nitrite  of  amyl,  TTlij  to  Hlv,  by  inhalation  ;  not 
more  than  KTliij  should  be  administered,  unless  the  patient  has 
been  accustomed  to  its  use. 

Dental  Uses. — As  an  antidote  for  chloroform  narcosis,  for  the 
relief  of  eipileptic  attacks  during  the  extraction  of  teeth,  for 
relieving  the  pain  of  neuralgia  of  the  fifth  pair  of  nerves,  and  for 
restoration  from  syncope.  As  nitrite  of  amyl  is  a  powerful  and 
dangerous  agent,  care  must  be  observed  in  its  use,  and  but  small 
doses  applied  at  first,  as  some  patients,  especially  the  weak  and 
nervous,  are  very  susceptible  to  its  influence. 

ANTHEMIS— CHAMOMILE. 

Source. — The  flowers  of  the  Anthemis  Nohilis.  A  German 
variety  is  known  as  Matricaria.,  which  is  similar  to  Anthemis 
in  its  effects.  The  herb  chamomile  has  a  fragrant  odor  and  a 
bitter,  aromatic  taste.  A  volatile  acid  is  obtained  from 
the  flowers,  which  is  similar,  if  not  identical,  with  valerianic 
acid. 

Medical  Properties  and  Therapeutic  Uses. — Chamomile  is  a 
mild  tonic  in  small  doses,  but  in  large  doses  may  act  as  an 
emetic.  It  is  used  in  the  form  of  a  cold  infusion  in  enfeebled 
digestion,  flatulent  colic  and  infantile  disorders  connected  with 


ANTIKAMNIA.  289 


digestive  derangement.  It  is  also  employed  in  the  form  of 
infusions  prepared  with  hot  water  and  vinegar,  for  the  relief  of 
pain  of  boils,  abscesses,  etc.  When  employed  for  the  relief  of 
odontalgia  in  the  form  of  fomentations  to  the  face,  there  is 
danger  of  the  abscess  pointing  externally  ;  it  is  also  applied  to 
flabby,  ill-conditioned  ulcers  as  a  gentle  excitant.  The  tepid  in- 
fusion will  promote  the  operation  of  emetics. 

Dose. — Of  the  powder  as  a  tonic,  5ss  to  oj.  It  is  generally 
employed  in  the  form  of  infusion. 

ANTIKAMNIA. 

Derivation. — Antikanmia  (non  official)  is  composed  of  acetan- 
ilid,  bicarbonate  of  soda,  and  citrate  of  caffeine,  so  combined,  it 
is  claimed,  as  to  obviate  the  bad  effects  caused  by  many  of  other 
organic  bodies  when  administered  alone.  It  is  in  the  form  of  a 
white  powder  with  a  pungent  taste. 

Medical  Properties.^  Physiological  Action.,  and  Therapeutic  Uses. — 
Antikamnia  is  an  antipyretic,  analgesic  and  anodyne,  and  causes 
a  quieting  influence  upon  the  nervous  system,  inducing  and  pro- 
moting sleep.  It  is  employed  in  neuralgia,  myalgia,  sciatica, 
acute  rheumatism,  hemicrania,  typhoid  fever;  also  headache  and 
other  neuroses  due  to  irregularities  of  menstruation ;  also  in 
asthma,  hay  fever,  influenza,  la  grippe  and  allied  affections. 

Dose. — Grs.  V  to  grs.  x,  every  three  or  four  hours. 

Dental  Uses. — For  the  relief  of  nervous  irritation,  and  also 
neuralgic  pain,  following  dental  operations,  and  the  pain  due  to 
dental  diseases,  ten  grains  of  antikamnia  will  prove  serviceable; 
also  in  the  odontalgia  of  pregnancy,  reflex  neuroses,  etc.  As  a 
local  application  for  pain  of  an  exposed  pulp,  periodontitis, 
alveolar  pyorrhoea,  etc.,  a  five  grain  tablet  may  be  finely 
powdered,  and  rubbed  about  the  affected  part ;  also  for  the  pain 
following  the  extraction  of  teeth  it  proves  serviceable. 

To  Prevent  the  Disturbajice  of  the  Nerv-  i      ,      ■  j    a      j 

■'  Analgesic  and  Anodyne, 

ous  System  which    Accompanies  tJu 

Administration  of  Quinine.  B  •    Antikamnia     .    .    .    .     3  ij 

r»       A    ^-i  Spts.  Vin.  Gall  .    .    . 

K.    Antikamnia     .    .    .    .      zss  ^  _. 

c  1  u  ^      c  r\  ■   •  -\-  ivf  Syr.  Aurantii  Flor.   aii    5iv.      M. 

Sulphate  of  Quinine  .  31J.         M.  ^  ^ 

Make   xii  capsules,  i    every  2  or  4       Signa.— Tablespoonful    every    3  or  4 
hours  as  may  be  indicated.  hours. 

19 


290  DENTAL  MEDICINE. 

Anodoyne  and  Analgesic.  ^"1^.  Doveri  ....    grs.  viii 

Soda  bicarb grs.  xij. 

R.    Antikainnia  ...  tt.      ••■  i 

"^  rt.  viij  capsules. 

Quinia  sulph aa^ss  y^^  ^      r\  i  i 

^  '^  ^  DObE. — One  capsule  every  4  hours. 

ANTIPYRINE— DIMETHYLOXYQUINIZINE. 

Formula. — CuHjjNgO. 

Antipyrine  in  is  the  form  of  whitish  or  grayish-white  crystal- 
line powder,  slightly-bitter  sweetish  taste,  and  soluble  in  water. 
It  combines  with  acids  to  form  salts. 

Medical  Properties  and  Therapeutic  Uses. — Antipyrine  is  a 
powerful  antipyretic,  local  anaesthetic,  disinfectant,  hemostatic 
and  stomachic  tonic,  and  acts  as  an  antiseptic  in  preventing 
fermentative  changes  in  the  intestines.  It  is  also  slightly  hyp- 
notic. It  stimulates  the  secretions  and  readily  diffuses  into  the 
blood.  It  first  stimulates  and  then  paralyzes  the  nerve-centres, 
dilates  the  cutaneous  vessels,  and  increases  the  loss  of  heat  by 
radiation,  reducing  the  temperature  rapidly.  Sometimes  it  may 
cause  dangerous  symptoms,  such  as  a  feeble  pulse,  profuse  dia- 
phoresis and  collapse.  It  is  employed  in  typhoid  and  malarial 
fevers,  pneumonia,  phthisis,  neuritis,  sciatica,  locomotor  ataxis, 
neuralgia  of  the  fifth  pair  of  nerves  associated  with  neuritis  and 
sciatica,  migraine,  acute  rheumatism,  epilepsy,  chorea,  etc.,  and 
as  a  substitute  for  morphine,  and  in  the  morphine  habit. 

Its  administration  is  soon  followed  by  profuse  perspiration, 
coldness  of  the  surface,  slowed  pulse,  depression,  and  if  fever  is 
present  by  lowered  temperature  within  a  half  hour  after  taking 
the  drug.  In  health  its  use  may  cause  slight  nausea,  singing  in 
the  ears,  and  a  slight  decrease  in  the  temperature  of  the  body.  It 
has  no  efi^ect  upon  respiration,  but  acts  as  a  sedative  upon  the 
brain.  It  is  eliminated  by  the  kidneys,  appearing  in  the  urine 
about  three  hours  after  ingestion. 

Dose. — Grs.  v  to  grs.  Ix,  being  determined  by  its  uses.  Sub- 
cutaneously  injected,  it  is  very  effective  in  painful  affections  orig- 
inating in  the  nerves. 

The  hypodermic  use  of  antipyrine  has  given  very  satisfactory 
results  in  the  treatment  of  nervous  articular  and  muscular  pains, 
gastric  affections,  bronchial  asthma,  articular  rheumatism,  chronic 


ANTIPYRINE.  291 


lumbago.  A  painless  injection  may  be  made  by  half-filling  a 
hypodermic  syringe  with  a  fifty  per  cent,  solution  of  antipyrine, 
which  will  amount  to  about  five  and  a  half  grains  ;  then  immerse 
the  syringe  into  a  ten  per  cent,  solution  of  cocaine,  drawing  up 
enough  of  the  cocaine  into  the  syringe  to  make  it  about  three- 
fourths  full ;  this  will  amount  to  one-third  grain  of  cocaine. 
The  two  solutions  readily  mix  and  do  not  decompose,  and  may 
be  used  as  a  local  anaesthetic. 

Dental  Uses. — Antipyrine  is  used  hypodermically  with  great 
success  in  cases  of  severe  neuralgia  of  the  fifth  pair  of  nerves. 
Also,  in  cases  of  acute  pericemental  irritation,  and  in  reflex 
neuroses  of  dental  origin  it  has  given  great  relief.  Fifteen  grains 
in  half  an  ounce  of  water  have  given  relief  in  a  case  of  perice- 
mentitis, ceasing  in  twenty  minutes  with  no  return  of  the  pain : 
but  many  prefer  antifebrin  (acetanilide)  as  being  safer  than  anti- 
pyrine. It  also  has  a  marked  effect  in  controlling  hemorrhage 
from  the  gums  and  alveolar  cavities  when  used  as  a  hemostatic 
after  the  extraction  of  teeth.  Prof.  G.  Cesari  claims  that  anti- 
pyrine more  or  less  speedily  arrests  hemorrhage  from  both  large 
and  small  blood  vessels  when  applied  in  solutions  of  not  less  than 
forty,  or,  better,  fifty  per  cent.  The  solution  as  well  as  the 
powder  should  be  applied  on  pledgets  of  cotton  wool.  Antipy- 
rine has  also  been  administered  internally  with  satisfactory  results 
in  the  treatment  of  periodontitis ;  and  in  cases  where,  owing  to 
the  severity  of  the  symptoms  in  the  same  affection,  the  internal 
administration  has  proven  unsuccessful,  the  hypodermic  injection 
of  fifteen  grains  has  afforded  relief;  or  the  hypodermic  injection 
followed  in  one  half  hour  by  the  internal  administration  of  fifteen 
grains  of  the  drug  will  afford  relief  in  cases  of  acute  periodontitis. 

Antipyrine  has  been  successfully  used  for  arresting  hemorrhage 
after  the  extraction  of  teeth,  as  it  has  none  of  the  disagreeable 
effects  of  perchloride  of  iron.     It  is  applied  on  cotton. 

For  Nervous  Cases. 
R .       Antipyrine gr.xviij 

Aq.  destillat q.s.  ad  ft.  sol. 

Ft.  sol  et  adde 

Acidi  valerianici gtt.xv. 

Shake  well  and  stand  aside  to  allow  salt  to  crystallize. 


292  DENTAL  MEDICINE. 

Local  ArtiBsthetic. 
Dr.  J.  E.  Davis. 

R.       Antipyrine  (5  percent.) grs.xxiij 

Cocaine  (10  per  cent.) grs.48 

Menthol grs.v 

Oil  cloves gtts.iij 

Ether gtts.xx 

Glycerine    .    .    •        3J 

Water   (pure) ^j?  M. 

SiGNA. — Use  with  hypodermic  syringe. 

ANTISEPTIC  AND  STYPTIC  COTTON-WOOL. 

Antheptic  Cotton. — First  free  the  ordinary  cotton  wool  from 
grease,  by  macerating  it  in  benzine  for  ten  minutes,  press  and  dry 
in  the  air.  Then  steep  the  purified  cotton,  for  ten  minutes,  in  a 
solution  of  tannin  5,  carbolic  acid  4,  alcohol  50,  and  castor  oil  8 
parts. 

Styptic  Cotton-Wool. — Purify,  as  before,  with  benzine,  dry  in 
air,  and  then  steep  it  in  a  solution  of  alum  2,  water  12,  chloride 
of  iron  solution  2  parts ;  dry  at  60°  C. 

AQUA  DESTILLATA— DISTILLED  WATER. 

Derivation. — "  Take  of  water  80  pints.  Distill  two  pints, 
using  a  tin  or  glass  condenser,  and  throw  them  away ;  then  distill 
64  pints,  and  keep  them  in  glass  bottles." — U.S.D. 

Properties. — Distilled  water  has  a  vapid,  and  by  no  means 
pleasant  taste,  and  is  only  perfectly  pure  when  the  vessel  used  in 
the  distillation  is  of  silver.     It  should  evaporate  without  residue. 

Therapeutic  Uses. — It  is  very  essential  in  the  preparation  of 
some  formulae,  and  of  no  use  whatever  in  others,  as  the  common 
pure  water  will  answer.  Such  agents  as  tartar  emetic,  nitrate  of 
silver,  corrosive  sublimate,  chlorides  of  calcium,  barium,  acetate 
and  subacetate  of  lead,  permanganate  of  potassa,  the  sulphates  of 
iron  and  zinc,  sulphate  of  quinia,  the  salts  of  morphia,  and  all 
the  alkaloids  and  their  salts,  require,  when  given  in  solution,  dis- 
tilled water. 

Dental  Uses. — Distilled  water  is  required  in  the  preparation  of 
many  formulae  for  use  in  dental  practice. 


NITRATE   OF   SILVER.  293 

ARGENTI  NITRAS— NITRATE  OF  SILVER. 
LUNAR  CAUSTIC. 

Formula. — AgNOg. 

Derivation. — Nitrate  of  Silver  is  obtained  by  dissolving  silver 
in  nitric  acid  and  distilled  water,  and  evaporating  the  solution. 
It  is  in  the  form  of  a  heavy,  colorless,  anhydrous  salt,  and  crys- 
tallizes in  shining,  rhombic  plates.  The  action  of  light  and  or- 
ganic matters  cause  it  to  turn  black.  It  is  wholly  soluble  in  dis- 
tilled water,  the  only  preparation  of  water  that  should  be  em- 
ployed in  forming  solutions  of  this  salt.  It  has  a  strong,  metallic, 
styptic  taste.  In  the  preparation  of  the  solid  form  of  sticks,  it 
is  first  melted  and  poured  into  moulds,  exposure  to  the  light  caus- 
ing the  sticks  to  become  gray,  and  more  or  less  dark,  owing  to 
the  reduction  of  the  silver  by  the  sulphuretted  hydrogen  contained 
in  the  atmosphere  ;  hence,  on  account  of  the  decomposition  of 
this  salt,  it  should  be  carefully  excluded  from  the  light. 

Medical  Properties  and  Action. — Nitrate  of  silver  is  tonic,  anti- 
spasmodic, sedative  and  astringent,  but  not  irritant.  The  pure 
form  when  locally  applied  is  a  powerful  caustic,  very  superficial 
in  its  effects,  coagulating  the  albumen  with  which  it  comes  in 
contact,  and  forming  a  protective  coat  to  the  tissues  beneath.  It 
is  eliminated  very  slowly  from  the  system.  When  applied  to  the 
skin,  mucous  membrane,  or  ulcers,  it  produces,  at  first,  a  white 
appearance,  owing  to  its  union  with  the  coagulated  albumen  of 
the  cuticle,  but  this  gradually  changes  to  a  bluish-gray,  purple, 
and  finally,  black  color,  on  account  of  the  partial  reduction  of 
the  silver  by  the  sulphuretted  hydrogen.  Small  doses,  adminis- 
tered for  a  long  time,  give  a  peculiar  blue  appearance  to  the  skin. 
When  internally  administered,  it  has  an  astringent  action  on  the 
mucous  coats  of  the  intestines.  It  is  a  powerful  tonic  to  the 
nervous  system,  and  has  been  chiefly  employed  as  an  antispas- 
modic tonic.  It  is  chiefly  used  externally,  as  a  stimulant,  vesi- 
cant, and  escharotic.  If  applied,  even  lightly,  three  or  four  times, 
to  the  moistened  skin,  it  will  cause  vesication  in  a  ^^vi  hours. 
The  blue  appearance  on  the  skin,  when  small  doses  are  long  con- 
tinued, is  said  to  be  preceded  by  a  peculiar  blue  line  on  the  gums, 
like  that   from  lead  poisoning.     A  very  minute  quantity  of  this 


294  DENTAL  MEDICINE. 


salt,  when  internally  administered,  is  eliminated  by  the  kidneys, 
as  most  of  it  escapes  by  the  liver  and  the  intestinal  glands,  a  por- 
tion remaining  permanently  deposited  in  the  tissues,  when  its  use 
has  been  long  continued.  Six  weeks  is  the  length  of  time  it  is 
safe  to  continue  its  internal  use,  and  during  that  time  occasional 
purgatives  should  be  given,  to  promote  its  elimination.  The  per- 
sistent use  of  iodide  of  potassium  and  the  hyposulphite  of  soda 
will  cause  the  absorption  and  excretion  of  the  silver  deposits,  in 
cases  of  skin  discoloration  from  its  long-continued  use,  aided  by 
baths  of  the  hyposulphites,  and  the  very  careful  use  of  lotions 
containing  cyanide  of  potassium,  which  possesses  a  solvent  power 
over  silver  deposits.  As  long  as  inflammation  is  present,  it 
should  not  be  internally  administered,  and  during  a  course,  it 
should  be  occasionally  intermitted  for  a  few  days,  and  a  purga- 
tive used.  The  gums  and  fauces  should  be  frequently  examined, 
and  if  the  slightest  blue  discoloration  is  observed,  the  remedy 
should  be  discontinued.     Exposure  to  the  sun  should  be  avoided. 

Therapeutic  Uses. — Nitrate  of  Silver  is  internally  employed  in 
dyspepsia,  chronic  gastritis,  chronic  diarrhoea  and  dysentery, 
cholera,  diseases  of  the  eye,  chorea,  epilepsy,  asthma  and  whoop- 
ing-cough. 

Externally  in  ophthalmia  and  other  diseases  of  the  eyes,  cu- 
taneous diseases,  diphtheria,  erysipelas,  hydrophobia,  enlargement 
of  glands,  diseases  of  the  genito-urinary  organs,  diseases  of  the 
ear,  burns,  ulcers,  hemorrhage,  etc.,  etc. 

Dose. — Of  nitrate  of  silver,  gr.  i,  gradually  increased  to  gr.  i^ 
three  times  a  day,  in  pill  made  of  some  vegetable  powder,  or  in 
solution.  The  fused  nitrate  of  silver — Argenti  Nitras  Fusa — or 
solid  form,  is  used  externally. 

Dental  Uses. — Nitrate  of  silver  is  one  of  the  comparatively 
limited  number  of  astringents  applicable  to  mucous  surfaces  which 
are  not  irritant  as  well  as  astringent.  For  inflamed  and  ulcerated 
conditions  of  the  mucous  membrane  of  the  mouth,  nitrate  of 
silver  is  a  valuable  application,  in  the  form  of  injections  or  so- 
lutions of  various  strengths,  from  gr.  ij  to  5ss  of  distilled  water ; 
also  in  diseases  of  the  antrum  and  ristula,  as  an  injection.  It  is 
also   used  as  a  styptic,  for  the  arrest  of  alveolar  hemorrhage,  but 


NITRATE   OF   SILVER.  295 

is  not  so  reliable  as  tannic  acid,  gallic  acid,  etc.,  on  account  of 
the  coagulum  or  clot  formed  by  it,  being  soluble  in  an  excess  of 
albumen.  It  is  also  employed  to  obtund  the  sensitiveness  of 
dentine,  especially  where  the  cause  is  mechanical  abrasion  ;  also 
in  aphthae,  mercurial  stomatitis,  ulceration  of  the  gums,  salivary 
fistula,  alveolar  abscess.  For  obtunding  sensitive  dentine,  the 
stick  form  (one  end  of  a  stick  inserted  into  a  quill,  or  fused  on 
the  end  of  a  platinum  wire)  is  employed;  or  the  end  of  a  silver 
wire  may  be  immersed  in  nitric  acid,  and  applied  to  the  sensitive 
surface,  taking  care  to  limit  its  action  to  the  part  on  which  it  is 
to  act.  When  applied  to  sensitive  dentine,  it  acts  on  the  gelat- 
inous portion  of  the  tooth,  destroying  its  vitality  to  the  extent  of 
the  combination  which  takes  place.  The  objection  to  its  use  in 
such  cases  is  the  discoloration  it  causes. 

Dr.  C.  N.  Peirce  recommends  saturating  blotting  paper  with  a 
40  per  cent,  solution  of  nitrate  of  silver  for  application  to  chil- 
dren's teeth,  as  it  cauterizes  the  soft  issues  and  acts  upon  the 
hard  in  a  satisfactory  manner,  without  danger  or  staining  the 
fingers ;  asbestos  paper  or  felt  may  also  be  saturated  with  the 
nitrate  of  silver  for  use  in  the  mouth.  Dr.  Kirk  recommends 
thin  asbestos  felt,  as  being  better  than  paper.  Before  saturating 
the  asbestos  felt,  it  should  be  heated  to  redness  over  a  Bunsen 
burner  to  burn  out  any  organic  matter  with  which  it  may  be  ac- 
cidentally contaminated. 

Dr.  Black  recommends  nitrate  of  silver  as  useful  in  the  treat- 
ment of  caries  of  the  teeth  "  under  some  certain  conditions ;  " 
mostly  in  deciduous  teeth,  but  occasionally  in  the  permanent 
teeth  also.  His  method  is  as  follows  :  In  the  case  of  broad,  shal- 
low cavities  in  children's  teeth,  a  full  exposure  of  the  decayed 
area  as  practicable,  is  made,  and  then  the  outer  portion  of  the 
carious  material  only  should  be  removed.  Then  the  rubber  dam 
is  adjusted,  the  decayed  area  dried,  and  some  pulverized  nitrate 
of  silver  is  laid  upon  the  carious  area,  with  just  enough  of  water 
to  dissolve  it,  and  insure  the  saturation  of  the  whole  of  the 
softened  dentine.  This  should  remain  from  five  to  fifteen  min- 
utes, the  longer  time  if  the  patience  of  the  child  will  allow, 
the  surplus  removed  with  absorbent  cotton,  and  the  cavity  lightly 


296  DENTAL  MEDICINE. 


washed  with  water  and  again  dried.  After  such  treatment  the 
carious  cavity  should  assume  a  deep  black  color  within  two  or 
three  days.  In  cavities  so  treated  the  progress  of  decay  will  gen- 
erally be  arrested  either  permanently,  or  for  a  considerable  time. 

As  salt  decomposes  the  nitrate  of  silver,  a  solution  of  the 
chloride  of  sodium  will  relieve  the  excessive  pain  following 
its  application  to  sensitive  dentine,  or  to  ulcers  of  the  mouth  ; 
such  a  solution  will  also  remove  recent  stains,  if  followed  by 
the  application  of  a  solution  of  ammonia.  Old  stains  may 
be  removed  with  tincture  of  iodine,  followed  by  cyanide  of 
potassium. 

A  convenient  way  to  keep  nitrate  of  silver  ready  for  use  is.  to 
soak  asbestos  fibre  in  a  saturated  solution,  and  allow  it  to  dry. 

The  antidote  in  cases  of  poisoning  by  nitrate  of  silver  is 
chloride  of  sodium  (common  salt),  which  converts  it  into  chloride 
of  silver,  to  be  followed  by  emetics,  and  the  proper  antiphlogistic 
treatment.  A  solution  of  cyanide  of  potassium  will  remove 
recent  stains  of  nitrate  of  silver. 


DENTAL  FORMULA. 

For  Inflamed  and  Ulcerated  Mucous  ^<^  Ulcers  and  Aphtha. 

Membrane.  ^       Argenti  nitratis  .    .    .    .  ^ss 

K.     Argenti  nitratis    .    .  gr.  ij  to  ^ss  Aqus  destillatje  .    .    .    .  |j.    M, 

Aquae  destillatae  .    .  f^j.           M.  SiGNA. — To  be  applied  with  a  camel 's- 

SlGNA.— To  be  used  as  a  lotion.  ^^ir  brush. 

For  Diseases  of  the  Antrum.  For  Mercurial  Stomatitis. 

R .    Argenti  nitratis    .    .  gr.  j  to  gr.  v  R .     Argenti  nitratis    .    .    .  gr.  ss 

Aquse  destillatae  .    .    .  f  Jj.         M.  Aquce  destillatae    .    .    .  f^j.     M. 

SiGNA. — To  be  used  as  an  injection.  SiGNA. — To  be  used  as  a  mouth  wash. 


ARISTOL— DITHYMOL-DIIODIDE— DITHYMOLBINIODIDE. 

Formula.— C^^.J^O\\. 

Derivation. — Aristol  is  obtained  by  adding  a  solution  of  iodine 
in  iodide  of  potassium,  to  an  equal  solution  of  hydrate  of  sodium, 
containing  thymol.  It  is  in  the  form  of  a  red-brown,  precipitated, 
amorphous,  non-crystallizable  powder.     The  proportion  of  iodine 


ARISTOL.  297 

in  aristol  has  been  estimated  by  Carius  at  45.80  per  cent.  Aris- 
tol  is  insoluble  in  water  and  glycerine,  slightly  soluble  in  alcohol, 
but  readily  soluble  in  chloroform,  ether,  and  in  the  essential 
oils ;  but  the  solution  must  be  made  by  friction  without  heat, 
as  the  aristol  is  decomposed  by  heat  and  also  by  the  light.  It 
possesses  but  a  slight  odor,  like  that  of  thymol,  and  is  not  un- 
pleasant. 

Medical  Properties  and  Therapeutic  Uses. — Aristol  possesses  no 
irritant  action  upon  the  unbroken  skin,  and  when  applied  to  mu- 
cous membrane  it  promotes  absorption.  Not  being  absorbed,  it 
has  no  toxic  effect,  and  for  such  reason,  together  with  its  freedom 
from  disagreeable  odor,  it  possesses  a  great  advantage  over  iodo- 
form. It  produces  rapid  healing,  and  has  been  employed  with 
benefit  in  varicose  ulcers  as  a  dusting  powder;  also  in  cutaneous 
diseases,  gonorrhoea,  gleet,  in  operations  of  anal  fistula,  abscess, 
lymphadentitis,  periostitis,  psoriasis,  ulcers,  etc.,  etc.  It  is  chiefly 
employed  as  a  dusting  powder,  or  in  ethereal  solutions  or  oint- 
ments, for  epithelioma,  burns  and  scalds.  Aristol  is  considered  to 
be  an  excellent  and  prompt  antiseptic,  but  the  name  is  merely  an 
assumed  one  for  dithymoldic  iodine.  Impurities  in  aristol  would 
be  all  the  by-products  derived  from  unskillful  treatment ;  it  might 
contain  potassium,  or  sodium  iodide,  or  free  iodine ;  it  might  be 
adulterated  even,  for,  as  a  patented  article,  it  is  above  control,  as 
patents  have  been  granted  by  the  U.  S.  Patent  Office  for  its  con- 
trol, manufacture  and  sale  under  the  name  of  "  aristol,"  being  a 
compound  of  thymol  with  iodine.  The  virtue  of  aristol  over 
iodoform,  etc.,  has  not  as  yet  been  so  pronounced  as  to  exclude  it 
from  the  general  class  of  patented  medicines. 

Dental  Use. — Aristol  has  been  used  as  a  substitute  for  iodo- 
form, iodol,  carbolic  acid,  etc.,  etc.,  in  all  cases  when  the  ordinary 
antiseptics  are  indicated,  as  in  gangrenous  pulps,  antisepticizing 
of  root-canals,  disinfection  of  cavities  before  the  introduction  of 
fillings,  in  the  form  of  a  10  per  cent,  solution  in  sulphuric  ether 
for  disinfecting  purposes;  for  gangrenous  pulps,  the  aristol  in 
powdered  form  may  be  applied  with  a  small  brush.  Sticks  made  of 
cacao  butter  10  parts,  and  aristol  i  part,  may  be  used  to  promote 
granulation  and  healing,     Aristol   has   the    advantage    of   being 


298  DENTAL  MEDICINE. 


effective  in  small  quantities,  and  may  be  diluted  with  sugar  of 
milk. 

Dr.  E.  C.  Kirk  highly  recommends  aristol  for  aveolar  pyor- 
rhoea, a  10  per  cent,  solution  being  rubbed  upon  a  glass  plate  with 
oil  of  cinnamon  and  introduced  into  each  suppurating  pocket,  and 
around  the  root  at  the  base  of  each  pocket,  on  threads  of  absorb- 
ent cotton  saturated  with  the  solution  ;  the  oil  of  gaultheria  may 
be  substituted  for  the  oil  of  cinnamon  if  desired.  Dr.  Kirk  and 
others  also  recommend  aristol  in  the  essential  oils  as  a  medica- 
ment for  canal-dressings,  and  as  a  topical  dressing  in  acute  pul- 
pitis. Dr.  Kirk  recommends  that  as  a  root-canal  dressing,  its 
use  should  be  strictly  confined  to  those  cases  where  pericemental 
inflammation  is  not  a  present  factor,  as  it  does  not  possess  anti- 
septic qualities  sufficiently  powerful  to  overcome  quickly  septic 
conditions  due  to  the  putrefactive  changes  common  in  root-canals. 
He  also  finds  it  extremely  valuable  in  connection  with  gutta 
percha,  as  an  antiseptic  in  conjunction  with  permanent  root  fill- 
ings— aristol  with  chloroform  being  used  to  dissolve  the  gutta 
percha.  It  is  also  recommended  as  an  ingredient  of  nerve  paste, 
being  equal  to  iodoform  for  such  a  purpose,  but  free  from  the 
disagreeable  odor  of  the  latter  substance ;  it  is  also  used  in  chloro- 
form solution,  instead  of  sandarach  varnish,  for  saturating  cotton 
used  for  wedges  or  temporary  fillings  for  retaining  medicaments  in 
cavities  in  the  teeth ;  such  a  dressing  or  wedge  may  be  retained 
for  days  or  a  week,  and  being  antiseptic,  it  is  free  from  disagree- 
able odor  during  that  time.  Aristol  is  also  recommended  as  a 
dressing  where  approximal  caries  has  extended  beyond  the  gum 
margin,  and  where  hypertrophy  of  the  gum  festoon  occurs  to  the 
degree  of  forming  a  polypoid  growth  which  invades  the  cavity  ; 
also  in  the  form  of  a  varnish  it  is  combined  with  collodion  as  a 
pulp-capping  material.  To  increase  the  adhesiveness  of  the 
aristol  solution,  a  small  quantity  of  Canada  balsam  may  be 
added  to  it. 

Dr.  R.  M.  Chase  recommends  an  aristol  chloro-percha  root 
filling  composed  of  two  grains  of  aristol  in  one  drachm  of  chloro- 
percha. 


ARNICA.  209 


DENTAL    FORMULAE. 


For    Alveolar   Abscess     and    Necrosed 

Teeth. 

Dr.  S.  Clipi'inger. 

K.     Aristol 3J 

Chlorofoimi Jjss 

01.  Cassise Til''-     '^^• 


For  Ulcers,  Burns,  Eczema,  etc. 
Dr.  Potter. 
R.     Aristol  .....  gr.v 

Etheris 

Alcoholis  .    .    .    .  iia^ij 
Saponis  (soft)  .    .    .  3J.  M. 

SiGNA. — Use  as  a  liniment. 


SiGNA. — Apply     on     cotton    wrapped  ta-      ,      ,1  11, 

,  ,,  ,         ,  Dissolve  the  aristol  in  the  ether  and 

around  a  small  broach.  ,,,,,- 

alcohol  and  then  incorporate  the  soap. 

ARNICA. 

leopard's  bane. 

Source. — Arnica  Montana  is  a  perennial  herbaceous  plant  of 
which  the  dried  flowers  and  root — Arn'icce  Flores  and  Arnicee 
Radix — are  the  medicinal  portions,  and  is  found  in  the  mountains 
of  Northern  Europe  and  the  Northwestern  portions  of  America. 

Medical  Properties  and  Action. — Arnica  is  nervine,  stimulant, 
and  diaphoretic.  In  over-doses  it  is  an  acro-narcotic  poison, 
causing  vomiting,  purging,  vertigo,  tetanic  twitching  of  the 
muscles,  and  convulsions.  Moderate  doses,  when  long  con- 
tinued, are  liable  to  cause  a  very  troublesome  eruption.  Its 
activity  depends  upon  an  alkaloid — Arnicina.,  which  is  a  bitter 
and  acrid  extractive. 

Therapeutic  Uses. — Arnica  is  administered  internally  in  typhus 
and  typhoid  fevers,  chronic  dysentery,  rheumatic  gout,  etc.,  etc. 
Externally  to  bruises,  sprains,  lacerations,  chilblains,  etc.,  in  the 
form  of  tincture — Tinctura  Arnica.  The  antidote  for  poison  by 
arnica  is  common  vinegar. 

Dose. — Of  the  extract  of  arnica,  gr.  v  to  gr.  x.  Of  the  tinc- 
ture of  arnica  (arnica  root  5j,  rectified  spirit  Oj),  the  dose  is 
lUx  to  r5ss. 

Dental  Uses. — In  dental  practice,  the  tincture  of  arnica  is 
applied  to  irritable  pulps  of  teeth,  in  periodontitis  to  prevent  sup- 
puration, to  wounds  of  the  mucous  membrane  of  the  mouth, 
combined  with  glycerine,  to  abraded  surfaces  caused  by  artificial 
teeth,  and  with  tannic  acid  or  glycerine  of  tannin  for  ulcers  of 
the  mouth. 


300  DENTAL  MEDICINE. 


The  tincture  of  arnica,  when  largely  diluted  with  water,  forms 
an  efficient  mouth  wash  during  operations  upon  the  teeth. 
Equal  parts  of  tincture  of  arnica  and  glycerine  diluted  with  water 
form  an  effective  mouth  wash  in  inflammations  of  the  mucous 
membrane  of  the  mouth. 

DENTAL    FORMULAE. 

For  Abraded  Surfaces  of  the  Mucous  For  Ecchytnosis. 

Membrane  of  the  Mouth.  jj  .    Tincturoe  arnicte  .    .    .    .^ss 

R .    Tincturae  arnicae,  Liquor  ammonii  muriat.  J  ss 

Glycerini     ....     aii^j.     M.  Aquse ^v.      M. 

SiGNA.— To  be  used  as  a  lotion,  Signa,— To  be  used  as  a  lotion. 
Astringent   Mouth  Wash  in  Alveolar 

Fyorrhcea,  etc.  ^"^  Inflamed  and   Ulcerated  Mucous 

Dr.  J.  R.  Bell.  Mevibrane. 

R.    Tincturse  arnicse     .     .      3J  R-    Tincturse  arnicse  .    .    .    ^\] 

Acidi  Carbolic!     .     .     .  ITLxx  Glycerini ^^ij 

Tincturae  myrrhse     .     .    ^  ss  Aquse  rosae ^  ij 

Olei  gaultheri£e     .     .      g jss  Aquse  Destillatse  .    .    .    g  x.      M. 

Alcoholis     ....     2  ijss.    M.  Signa. — To  be  used  as  a  gargle. 

ATROPINiE  SULPHAS— SULPHATE  OF  ATROPINE. 
ATROPINE. 

Formula. — C17H23NO3. 

Derivation. — Sulphate  of  Atropine  is  obtained  by  adding  a 
mixture  of  sulphuric  acid  to  an  ethereal  solution  of  atropine.  It 
is  in  the  form  of  a  white,  slightly  crystalline  powder,  very  soluble 
in  water  and  alcohol,  but  insoluble  in  ether.  It  is  inodorous, 
and  of  a  bitter  taste. 

Medical  Properties  and  Action. — Sulphate  of  atropine  has  the 
same  medical  properties  and  action  as  belladonna,  of  which  it  is 
the  alkaloid,  but  is  far  more  energetic  in  its  action.  It  is  an 
active  poison,  and  should  only  be  administered  internally  with 
the  greatest  care.  Hypodermically  employed,  it  is  a  useful 
anodyne  and  antispasmodic,  and  the  quantity  should  be  cautiously 
increased  from  a  very  small  dose  in  the  beginning.  Such 
symptoms  as  dryness  of  the  throat,  vertigo,  and  diplopia,  are 
indications  that  its  use  should  be  discontinued.  Without  being 
a  direct  hypnotic,  it  induces  sleep  by  relieving  pain.     Although 


SULPHATE  OF  ATROPINE.  301 


it  is  not  so  well  tolerated,  as  a  general  rule,  as  is  morphine,  yet 
patients  who  cannot  bear  morphine  will  bear  atropine. 

Therapeutic  Uses. — See  Belladonna. 

Dose. — Of  sulphate  of  atropine,  gr.  jh  to  gr.  in  .  For  an 
anodyne  and  antispasmodic,  hypodermically  injected,  the  dose 
is  1fllij=gr.  lio,  as  a  commencement.  An  ointment  is  made  of 
atropine  gr.  viij,  rectified  spirit  foss,  lard  §j. 

The  antidote  in  cases  of  poisoning  by  Belladonna  and  its 
alkaloid  is  an  infusion  of  galls  and  lime  water,  first  evacuating 
the  stomach  as  speedily  as  possible. 

Dental  Uses. — In  dental  practice,  sulphate  of  atropine  is 
applied  externally  to  obtund  the  sensitiveness  of  inflamed  pulps 
of  teeth,  preparatory  to  their  treatment,  and  to  their  devital- 
ization •,  it  is  also  applied  to  acute  inflammations,  depending  upon 
alveolar  periostitis  and  abscess.  It  forms  one  of  the  ingredients 
of  a  nerve  paste,  for  devitalizing  pulps  of  teeth,  being  substituted 
for  the  acetate  of  morphine,  but  there  is  doubt  as  to  its  being  so 
effective  as  the  morphine  salts  ;  in  facial  neuralgia,  in  the  form 
of  an  ointment ;  in  neuralgia  and  in  profuse  salivation.  As  an 
anodyne  for  internal  use,  it  proves  eflicacious  in  relieving  intense 
pain,  such  as  may  result  from  an  inflamed  pulp  or  periosteum  ; 
also  internally,  or  in  the  form  of  hypodermic  injections,  for  the 
relief  of  facial  neuralgia;  for  such  a  purpose  120  of  a  grain  of  the 
atropine  sulphate  is  often  combined  with  morphine  sulphate. 

DENTAL    FORMULA. 
For  Facial  Neuralgia.  For  Facial  A'euralgia. 

R.    Atropine  sulphat.  .    .      gr.j  R.    Pulverisbelladonnoe  .    .  gr.x 

Adipis 3J.        M.  Camphorce 5  ss 

SiGNA.— To  be  applied  in  the  form  of  Spiritus  rectificati  .     .       q.s.       M. 

an  ointment,  over  seat  of  pain.  Signa.— To  be  applied  with  a  camel's- 

hair  brush. 
For  A'eiiralgia. 

T    T      T  For  A^etiralzia  of  Superficial  Nerves. 

J.  L.   Ludlow.  -^       y       /    y 

r>         ».         •  11.-  AlTKEN. 

li .    Atropine  sulphatis  .    .  gr.ss 

Aconitince gr.iss  R-    Atropine  sulphat.     .    .  gr.v 

Olei  tiglii gtt.ij  Aquse  destillat f,^iii.  ^L 

Ung.  petrolei  .    ...  ^ij.      M.  SiGNA. — L'se  on  a  compress  and  renew 

Signa. — Apply  externally.  several  times  in  24  hours,  and  con- 


302  DENTAL  MEDICINE. 


tinue  for  at  least  one  hour  at  a  time,       Signa. — To  be  applied  as  a  lotion,  on 
covering    with    oilskin,    to    prevent  lint  saturated  with   it,  and   covered 

evaporation.  with  oiled  silk. 

For  Facial  Neuralgia. 
U .    Ext.  belladonnae  .    .    .   gr.ss 

Quininae  sulphat.  .    .     gr.ij.       M.        For  N^euralgia  in  Superficial  Nerves^ 

Ft-Pil-No.  I.  J,       chloroformi, 

SiGNA.-Use  3  times  daily.  gp^^  ^j,^i  ^^^^  ..  ^^^ 

For  Facial  N^euralgia.  Atropinae  sulphat.  .    .  gr.v.       M. 

B .     Linimenti  belladonnae,  Signa. — To    be    applied    on    lint    to 

Linimenti  aconiti  .    .  aa  ^vij  painful  part,  and  covered  with  oiled 

Chloroformi f  3  ij.    M.  silk. 

For  Neuralgia. 

B  .         Ext.  belladonnae gr.iv 

Ext.  stramonii         gr.v 

^  Ext.  hyoscyami gr.v 

Quininae  sulphat Qij.  M. 

Ft.  pil.  No.  XX. 
Signa. — One  pill  2  or  3  times  a  day. 

AURUM   TERCHLORIDUM— TERCHLORIDE   OF  GOLD. 

Formula. — AUCI3. 

Derivation. — The  Terchloride  of  Gold  is  obtained  by  dissolv- 
ing gold  in  aqua  regia  (three  parts,  by  measure  of  hydrochloric 
acid,  and  one  of  nitric  acid),  using  gentle  heat  to  hasten  the  so- 
lution, the  acids  employed  being  chemically  pure.  The  solution 
is  then  evaporated  to  dryness,  when  ruby-red  prismatic  crystals 
of  the  terchloride  of  gold  result. 

Properties  and  Action. — Terchloride  of  gold  is  very  deliques- 
cent, and  is  soluble  in  water,  alcohol  and  ether.  It  possesses  a 
disagreeable,  styptic  taste,  reddens  blue  litmus  paper,  and  will  im- 
part a  purple  stain  to  the  skin,  which  may  be  removed  by  a  solu- 
tion of  cyanide  of  potassium.  It  is  readily  decomposed  by  many 
metallic  and  non-metallic  elements,  and  also  by  saline  and  or- 
ganic compounds,  on  account  of  its  elements  being  held  together 
by  a  feeble  affinity.  It  is  escharotic  and  disinfectant,  and  its  physio- 
logical effects  are  similar  to  those  of  corrosive  sublimate.  It  is 
not  used  internally. 

Dental    Uses. — In  dental   practice,  the   terchloride  of  gold,  in 


BELLADONNA  303 


the  form  of  an  aqueous,  alcoholic,  or  ethereal  solution,  is  employed 
for  the  purpose  of  obtunding  the  sensitiveness  of  dentine,  for 
which  it  is  a  valuable  application;  and  the  ethereal  solution  pos- 
sesses some  advantages  over  the  aqueous  or  alcoholic  solutions 
for  such  a  purpose.  To  prepare  an  obtunding  solution  :  *'  Dis- 
solve the  crystals  of  the  gold  in  pure  water;  fill  a  test-tube  half 
full  of  the  solution,  then  add  an  equal  quantity  of  sulphuric  ether, 
and  agitate  the  mixture.  Let  it  then  rest  for  a  few  minutes, 
when  the  ethereal  solution  will  rise  to  the  surface,  and  may  be 
poured  off  into  another  tube  or  phial,  and  securely  stoppered.  It 
should  be  kept,  as  much  as  practicable,  from  the  action  of  light 
and  air.  Applied  to  dentine,  on  pledgets  of  cotton,  it  acts  like 
chloride  of  zinc,  but  more  promptly  and  with  less  pain.  Chlo- 
rine is  more  abundantly  liberated  during  its  action  than  from 
chloride  of  zinc ;  hence  it  is  a  better  disinfectant  than  the  latter. 
It  has  a  fine  yellow  tint,  and  it  is  not  absorbed  by  the  dentine, 
but  forms  an  insoluble  compound  with  the  gelatinous  elements. 
As  it  is  an  irritant  poison,  care  should  be  observed  in  its  use.  If 
not  protected  in  a  glass-stoppered  bottle,  the  gold  is  precipitated 
in  a  metallic  form. 

BELLADONNA  FOLIA -BELLADONNA  LEAVES. 

BELLADONN/E   RADIX— BELLADONNA  ROOT. 

DEADLY    NIGHTSHADE. 

Source. — Belladonna  is  a  perennial,  herbaceous  plant,  found  in 
Europe,  the  leaves  and  root  being  the  medicinal  portions. 

Medical  Properties  and  Action. — Belladonna  is  anodyne  and  an- 
tispasmodic, its  activity  depending  upon  an  alkaloid.  Atropine. 
Belladonna,  in  small  doses,  is  a  valuable  narcotic  and  anodyne 
stimulant.  It  causes  a  peculiar  dryness  of  the  mouth,  fauces, 
stomach  and  intestines,  but  increased  secretion  follows,  especially 
in  the  case  of  the  latter  organs,  when  atropine  is  administered  or 
subcutaneously  injected.  In  larger  doses,  it  causes  dilatation  of 
the  pupils,  giddiness,  loss  of  vision,  difficult  deglutition,  constric- 
tion of  the  throat,  difficult  articulation,  increased  action  of  the 
heart,  quickened  respiration,  nausea,  vomiting,  diuresis,  purging, 


304  .  DENTAL  MEDICINE. 


and  sometimes  a  red  eruption.  It  is  eliminated  chiefly  by  the 
urine. 

Opium  is  the  antidote,  or  hypodermic  injections  of  morphine. 
When  applied  to  the  eyebrows,  belladonna  causes  dilatation  of  the 
pupils. 

Therapeutic  Uses. — Belladonna  is  extensively  employed,  either 
alone  or  in  combination  with  sulphate  of  quinia,  in  the  treatment 
of  neuralgia ;  also  in  mania,  Bright's  disease,  epilepsy,  lead  colic, 
spasmodic  affections,  diseases  of  the  cerebro-spinal  system,  as  a 
preventive  of  scarlatina,  night  sweats  of  phthisis,  etc. 

Dose. — Of  powdered  belladonna,  gr.  ss  to  gr.  j,  daily ;  of  the 
extract,  gr.  y^  to  gr.  j  ;  of  the  tincture,  gtt.  v  to  gtt.  xx.  Bella- 
donna should  not  be  given  immediately  before  or  after  meals,  as 
it  decreases  the  gastric  fluids.     (See  Atropine.) 

BENZOIC  SULPHIDE  OF  SODIUM. 

Benzoic  Sulphide  of  Sodium  is  obtained  by  dissolving  a  large 
quantity  of  benzoic  acid  in  a  concentrated  solution  of  sulphide  of 
sodium.  It  is  a  valuable  antiseptic  for  dressing  wounds,  and  may 
be  used  as  a  wash,  lotion  or  injection,  its  antiseptic  properties  be- 
ing very  active  and  healing.  Thirty  to  forty-five  grains  are  used 
to  the  quart  of  water.  Heckel  considers  it  to  be  equal  to  car- 
bolic acid,  and  superior  both  to  sublimate  and  iodoform,  as  it  is 
not  poisonous  like  corrosive  sublimate,  and  is  free  from  the  dis- 
agreeable eflFects  of  iodoform.  It  is  very  soluble  in  water  and 
contains  the  antiseptic  properties  of  its  two  principal  ingredients — 
benzoic  acid  and  sulphite  of  sodium.  It  is  harmless,  even  when 
given  in  large  doses. 

BISI^UTH  SUBNITRAS— SUBNITRATE   OF  BISMUTH. 

Formula.— B\0^0^+  HgO. 

Derivation — The  metal  Bismuth — Bismuthum^  Formula  Bi, 
from  which  the  subnitrate  is  obtained,  is  found  native  in  Europe 
and  America,  and  generally  in  combination  with  sulphur  and  ox- 
ygen. It  fuses  at  510°  F.,  and  is  brittle  and  pulverizable.  It  is 
employed  in  the  dental  laboratory  for  making  fusible  metal  alloys 
for  dies  and  counter-dies. 


SUBNITRATE  OF  BISMUTH.  305 

The  Subnitrate  of  Bismuth  is  obtained  by  dissolving  the  metal 
bismuth  in  dilute  nitric  acid,  and  converting  the  nitrate  thus 
formed  into  carbonate,  by  adding  a  solution  of  carbonate  of  so- 
dium, u^hich  is  then  dissolved  in  nitric  acid  and  the  nitrate  of  bis- 
muth again  formed,  which  is  vi^ashed  in  water  and  the  nitric  acid 
removed  by  ammonia.  Such  a  process  frees  it  from  the  arsenious 
acid  which  metallic  bismuth  generally  contains.  Subnitrate  of 
bismuth  is  in  the  form  of  a  heavy,  white  powder,  with  a  faint  acid 
odor  and  slightly  metallic  taste,  and  is  soluble  in  water.  Large 
quantities  are  poisonous,  with  symptoms  of  arsenical   poisoning. 

Medical  Properties  and  Action.  —  Subnitrate  of  bismuth  is 
sedative,  astringent  and  alterative.  Owing  to  the  formation  of  a 
sulphide,  it  coats  the  tongue  black,  and  its  continued  use  may 
give  rise  to  the  formation  of  a  bluish-red  line  on  the  gums, 
similar  to  that  resulting  from  the  use  of  lead,  except  that  the  line 
is  wider  and  deeper  in  color.  In  proper  doses,  it  promotes  the 
appetite  and  increases  the  digestive  power.  Being  somewhat  as- 
tringent, it  afFects  the  intestinal  movements,  and  can  be  detected 
in  the  blood,  urine,  and  other  secretions. 

Therapeutic  Uses. — -Subnitrate  of  bismuth  is  employed  in 
atonic  dyspepsia,  gastric  irritations  (milder  forms),  pyrosis,  gas- 
trodynia,  ulcer  of  the  stomach,  diarrhoea  from  debility,  etc. 
chronic  laryngitis,  epilepsy,  ringworm  (in  form  of  an  ointment 
.5j  to  lard  .5j),  chronic  skin  diseases,  chlorosis,  when  iron  is  not 
tolerated,  etc.,  etc.  If  not  well  borne  by  the  stomach,  it  may 
be  combined  with  aromatic  powder,  or  if  alkalies  are  indicated, 
with  chalk  and  xnagnesia. 

Bismuthi  subnitras  is  also  employed  as  an  antiseptic  dressing 
for  wounds,  to  promote  primary  union.  The  subnitrate  is  held 
in  suspension  in  water,  in  the  proportion  of  lo  per  cent.,  and 
during  the  operation  the  wound  is,  from  time  to  time,  sprinkled 
with  the  solution,  and  afterward  sealed  with  a  bismuth  paste,  and 
the  subsequent  dressings  made  in  the  same  manner. 

Dose. — Of  subnitrate  of  bismuth,  grs.  v-x  to  5j,  in  powder  or 
emulsion. 

Dental    Uses. — Subnitrate    of    bismuth    is   a    valuable    internal 
remedy  in    aphthae,  mercurial   salivation,   painful    ulcers  of   the 
20 


306  DENTAL  MEDICINE. 


mucous  membrane  of  the  mouth,  vomiting,  cholera  infantum, 
and  diarrhoea  of  children  during  painful  dentition.  It  is  best 
given  in  milk,  and  before  meals. 

For  cancrum  oris,  after  using  a  disinfecting  solution  to  cleanse 
the  gangrenous  part,  the  topical  application  of  subnitrate  of 
bismuth,  every  three  hours,  corrects  the  fetor,  arrests  the  progress 
of  the  gangrene,  and  hastens  cicatrization. 

DENTAL  FORMULA. 

For   Vomiting  and  Painful  Digestion  For  Diarrhoea  of  Dentition. 

of  Teething  Children,  Acidity  and       „       ^.        .1  •     .    -.    .  , 

■'         .  Ji  •     Bismuthi  subnitrat.  .    .  gr.  Ix 

y        '  Extract  rhei  fluid    .    .  gtt.  viij 

BaRTHOLOW.  CI  r-T 

byrup  rubus    .    .    .    .  1 3  ss 

R.     Bismuthi  subnitrat.     .  ^iij  Elixir  aurantii    .    .    .  f|ss.      M. 

Acid  carbol gr.  ij-gr.  iv  Signa.— A  teaspoonful  4  to  6  times  a 

Mucil.  acaciae  .    .    .    .  ^j  (lay.     Proper  feeding — barley  water, 

Aquae  menthae  pip.  .    .  ^  iij.      M.  milk  and  lime  water.     Starchy  food 

Signa. — A    tablespoonful    for   adults  prohibited, 
and  proportionate  quantity  for  chil- 

'  J       ^  J^'  For    Indigestion,    Cholera    Infantum, 

For    Gangrene   of  Mouth    ( Cancrum  Vomiting  and  Diarrhcea,  Disordered 

Oris).  Digestion. 

R .     Bismuthi  subnitras  (powd.)  R .     Bismuthi  subnitrat,  grs.  iij  to  vj 

Signa. — Applied  to  ulcerated  surface,  for  children,  every  hour,  or  grs. 

and  covered  with  absorbent  cotton.  v  to  x  or  xv  for  adults. 

Dermatol  is  a  basic  gallate  of  bismuth  in  the  form  of  a  fine 
safFron-yellow  powder,  odorless  and  innocuous.  It  is  insoluble 
in  water,  alcohol,  and  ether;  not  hydroscopic,  or  otherwise 
affected  by  air  or  light.  It  resembles  iodoform  in  appearance, 
and  possesses  astringent,  antiseptic  and  dessicant  properties.  It 
is  used  externally  in  wounds,  ulcers,  and  inflammations  of 
mucous  membranes,  and  is  of  especial  value  in  lesions,  attended 
by  profuse  secretion,  as  eczema,  burns,  ulcers,  wounds,  and 
diseases  of  the  eye  and  ear.  Internally,  it  is  employed  in 
diarrhoea,  etc.  As  an  antiseptic  it  prevents  putrefaction,  and 
also  the  development  of  bacteria  when  used  as  a  1. 10  per  cent, 
solution.  Dermatol  may  be  used  as  a  powder,  as  liquid  and 
paste,  in  emulsion  of  collodion,  glycerine,  and  essential  oils,  and 
as  an  ointment  with  lanolin  wax,  oxide  of  zinc,  and  paraffin. 


BROMIDES.  307 


BROMIDES. 

Bromides  are  diffusible  agents  which  rapidly  pass  into  the 
blood,  and  in  large  doses  can  be  detected  in  the  faeces  and  intesti- 
nal mucus,  owing  to  a  portion  of  the  agent  not  being  absorbed. 
They  depress  the  heart's  action,  and  also  respiration  and  animal 
temperature  ;  in  some  cases  large  doses  may  cause  transient  ex- 
citement, giddiness  and  intoxication.  Moderate  doses  have  a 
tranquillizing  effect  and  refreshing  sleep,  and  lower  the  sensibility 
to  pain  and  irritation.  Their  immoderate  use  will  cause  paralysis 
of  the  muscles,  and  a  condition  known  as  bromism^  the  symptoms 
of  which  may  be  extreme  pallor  and  anemia,  dilated  pupils,  slow 
and  feeble  action  of  the  heart,  breathlessness  and  quickened 
pulse  on  slight  exertion,  acne,  skin  eruption,  cool  extremities, 
tremulous  and  uncertain  movements,  want  of  tactile  feeling,  re- 
laxation of  the  genitals,  dry  fauces,  difficult  deglutition,  and  weak 
mind. 

Ammonii  Bromidum  —  Bromide  of  Ammonium.  Formula. 
— NH^Br.  In  the  form  of  colorless,  transparent  crystals,  or  a 
white  granular  salt,  with  a  pungent,  saline  taste,  neutral  reaction, 
and  no  odor.  Ammonii  Bromidum  is  soluble  in  1.5  parts  of 
water,  in  150  parts  of  alcohol  at  60°  F.,  and  in  0.7  part  of  boil- 
ing water. 

Dose. — Gr.  x  to  5ss,  considerably  diluted. 

Calcii  Bromidum  —  Bromide  of  Calcium.  Formula. — 
CaBrj.  In  the  form  of  a  white  granular,  deliquescent  salt,  with 
a  pungent,  saline,  bitter  taste,  and  no  odor.  It  has  a  neutral  re- 
action, and  is  soluble  in  0.7  part  of  water,  and  in  i  part  of 
alcohol. 

Dose.— '3]  to  5ij- 

LiTHii  Bromidum — Bromide  of  Lithium.  Formula. — LBr. 
In  the  form  of  white,  granular,  deliquescent  salt,  with  a  pungent, 
bitter  taste,  and  a  neutral  reaction.  Quite  soluble  in  water  and 
alcohol. 

Dose. — Gr.  V  to  .3ij. 

Sodii  Bromidum — Bromide  of  Sodium.  Formula. — NaBr. 
In  the  form  of  small  colorless  crystals,  or  a  white  crystalline 
powder,  with  a  saline  taste,  neutral  reaction  and  no  odor.     It  is 


308  DENTAL  MEDICINE. 


soluble  in  1.6  parts  of  water,  and  in  200  parts  of  water  at 
60°  F. 

Dose. — 9j  to  5'''  (See  Bromides  of  Potassium,  Camphor  and 
Ethyl.) 

Medical  Properties  and  Therapeutic  Uses. — The  bromides  have 
the  same  general  action  and  are  employed  for  the  same  purposes. 
The  bromide  of  lithium  is  considered  to  have  a  more  hypnotic 
influence  than  the  others;  and  the  bromide  of  sodium  is  gener- 
ally given  in  full  doses ;  the  others  in  rather  smaller  doses.  Prof. 
Bartholow  considers  the  bromide  of  potassium  to  possess  more 
toxic  power,  and  the  bromide  of  sodium  the  least.  As  regards 
their  influence  on  the  pulse,  body,  head  and  respiration,  the  same 
author  places  the  bromides  in  the  following  order:  bromide  of 
sodium,  bromide  of  lithium,  bromide  of  potassium,  bromide  of 
ammonium.  The  bromides  are  eliminated  through  the  kidneys 
chiefly ;  also  through  the  mucous  membrane  of  fauces,  bronchi, 
intestinal  canal  and  the  skin ;  several  days  being  required  for 
their  diffusion  outwardly  from  the  blood.  The  bromides  are  ad- 
ministered in  delirium  tremens,  insanity,  increased  action  of  the 
heart,  tetanus,  neuralgia,  epilepsy,  vaso-motor  disturbances,  spas- 
modic asthma,  abnormal  sexual  excitement,  nocturnal  seminal 
emissions,  vomiting  of  cerebral  congestion,  pregnancy  and  sea- 
sickness, cholera  infantum,  migraine,  strychnine-poisoning,  etc., 
etc.  Locally  in  pruritis,  prurigo,  eczema,  epithelioma,  old  ulcers, 
etc.     (For  Dental  Uses,  see  Bromide  of  Potassium.) 


BROMOL.— TRI-BROM-PHENOL,  BROMO-PHENOL. 

Formula.— C.USr^ViO. 

Derivation. — Bromol  is  a  compound  of  bromide  and  carbolic 
acid.  It  is  in  the  form  of  soft,  white  needles,  and  is  prepared 
by  treating  phenol  or  carbolic  acid  with  an  excess  of  bromine  in 
aqueous  solution. 

Medical  Properties  and  Therapeutic  Uses. — Bromol  possesses 
strong  antiseptic  properties,  and  at  the  same  time  is  non-toxic. 
Rademaker  recommends  it  for  external  use,  either  dissolved  in 
olive   oil  (i  in   30)  or  mixed   with   vaseline  (4  in  40).     It  may 


SULPHATE  OF  CADMIUM.  309 

also  be  employed  in  the  form  of  powder  like  iodoform,  for  sprin- 
kling in  wounds. 

It  is  also  used  internally  in  cholera  infantum,  typhoid  fever, 
etc.,  etc. 

Dose. — For  internal  administration,  the  dose  of  bromol  is  from 
15T  to  yl  grain. 

Dental  Uses. — The  uses  of  bromol  in  dental  practice  are  the 
same  as  iodol,  iodoform  and  other  antiseptics.  Good  results 
have  been  obtained  by  its  application  to  teeth  affected  with  alve- 
olar abscess  and  gangrenous  pulps. 

CADMII  SULPHAS— SULPHATE  OF  C^ADMIUM. 

^      Formula.— ^Cd?^O^^^W.p. 

Derivation. — Sulphate  of  Cadmium  is  obtained  by  the  action 
of  nitric  acid,  diluted  with  distilled  water,  on  the  metal  cadmium, 
the  solution  filtered  and  mixed  with  carbonate  of  soda,  and  again 
dissolved  in  sulphuric  acid  diluted  with  distilled  water.  It  is  in 
the  form  of  transparent,  colorless  crystals,  like  those  of  sulphate 
of  zinc. 

Medical  Properties  and  Action. — Sulphate  of  cadmium  is  emetic 
and  astringent,  and  closely  resembles  sulphate  of  zinc  in  its 
action,  but  is  stronger,  with  a  caustic  astringent  taste.  It  is  very 
nauseant  and  depresses  greatly.  Locally  it  is  an  irritant  poison, 
and  produces  the  cerebro-spinal  symptoms  of  coma  and  convul- 
sions ;  it  is  not  administered  internally,  as  the  preparations  of 
zinc  are  preferable  for  such  use. 

Therapeutic  Uses. — Sulphate  of  cadmium  is  employed  locally  in 
affections  of  the  eye,  being  valuable  as  a  coUyrium ;  it  has  the 
power  of  causing  absorption  of  opacities  of  the  cornea  to  a  re- 
markable degree.  It  is  also  used  as  an  injection  in  gonorrhoea, 
in  the  strength  of  one  grain  to  four  ounces  of  water.  It  is  also 
used  in  the  form  of  ointment,  two  grains  with  four  scruples  of  lard. 

Dental  Uses. — Sulphate  of  cadmium  has  been  employed  in 
ulcerations  of  mucous  membrane,  gangrene  of  the  mouth,  or  can- 
crum  oris,  indolent  ulcers,  purulent  diseases  of  the  antrum,  in  the 
form  of  injections  and  lotions,  of  a  strength  about  one  grain  of 
the  sulphate  to  four  ounces  of  water. 


310  DENTAL  MEDICINE. 


CAFFEINE— CAFFEINA. 

Derivation. — Caffeine  is  a  proximate  principle  of  feebly  alkaloid 
power,  generally  prepared  from  the  dried  leaves  of  Camellia 
Thea,  or  from  the  dried  seeds  of  Caffea  Arabica.  Caffeine  was 
first  extracted  from  coffee.  One  cup  of  good,  well-made  coffee 
contains  one-half  to  one  drachm  of  the  empyreumatic  oil,  which 
has  no  physiological  effects.  It  is  in  the  form  of  colorless,  silky, 
inodorless  crystals,  sparing  soluble  in  alcohol,  and  in  75  parts  of 
cold  water,  but  much  more  soluble  in  9.5  parts  of  boiling  water. 

Medical  Properties  and  Physiological  Jet  ion. — It  is  a  rapidly  act- 
ing stimulant  on  the  nervous  system,  its  chief  influence  being  on 
the  brain  and  spinal  column.  By  stimulating  the  muscles  of  the ' 
heart,  it  is  supposed  to  increase  the  pulse  rate  and  blood-pressure. 
It  has  a  decided  diuretic  action,  and  counteracts  the  effects  of 
narcotic  remedies — it  is  valuable  in  opium  poisoning,  but  is  not 
a  complete  antidote.  When  taken  into  the  stomach,  it  diffuses 
readily  into  the  blood,  and  is  eliminated  principally  by  the  kid- 
neys and  liver.  Small  doses  increase  the  appetite,  increasing 
peristalsis,  and  in  some  cases  causing  venous  conjestion  and 
hemorrhoids.  It  also  acts  as  a  powerful  stimulant  to  the  respira- 
tory centre. 

Therapeutic  Uses. — Caffeine'is  employed  in  neuralgia,  migraine, 
hemicrania,  dropsy,  cholera  infantum,  asthma,  cardiac  disease, 
being  a  valuable  cardiac  stimulant.  It  often,  however,  produces 
insomnia  to  such  a  degree  in  cardiac  disease,  that  its  use  has  to  be 
discontinued;  if  not,  delirium,  like  that  of  alcohol,  may  ensue. 
The  habitual  use  of  coffee  in  some  cases  may  also  cause  insom- 
nia, palpitation,  tremors,  tinnitus  aurium,  gastralgia  and  emacia- 
tion. Caffeina  alone  cannot  be  used  hypodermically  owing  to  its 
decomposition  in  the  presence  of  water. 

Dose. — Of  Caffeine,  gr.  ij  to  gr.  v  :  of  Citrate  of  Caffeine  gr. 
ij  to  gr.  V. 

Dental  Uses. — Caffeine  is  useful  in  facial  neuralgia,  migraine, 
hemicrania.  For  headache  from  nervous  strain,  caffeine  com- 
bined with  antipyrin  and  one  of  the  bromides  is  a  useful  and 
efficient  remedy. 


CAFFEINE-CAFFEINA.  311 

DENTAL    FORMULA. 
For  Facial  Neuralgia,  Migraine,  etc.  For  Facial  Neuralgia,  etc. 

R.     Caflfeinje gr.xx  R      Caffeinae  Citrat. .     .    .     ;5ss 

-,,  ^.  Amnionii  bromidi  .    .      ziii 

rhenacetin    ....  /Z-. 

Elix.  guaranae    .  .    .     13  ij.       M. 
Pulv.  aromatic  .    .  aa   ^ss.       M.       signa._A  teaspoonful  every  hour  or 
SiGNA. — A  powder  every  2  or  3  hours.  two  until  pain  is  relieved. 

CALCII  HYPOPHOSPHIS— HYPOPHOSPHITE  OF  LIME. 

Formula.— Q2.Y{1?0^^. 

Derivation. — The  salt,  Hypophosphite  of  Lime  is  obtained  by 
boiling  phosphorus  in  a  mixture  of  hydrate  of  lime  in  boiling 
water,  until  phosphoretted  hydrogen  escapes,  and  phosphate  and 
hypophosphite  of  lime  are  formed  in  the  solution,  which  is  then 
filtered  and  evaporated  over  sulphuric  acid,  when  the  salt  is  crys- 
tallized out  in  the  form  of  white,  pearly  crystals,  with  a  nau- 
seous, bitter  taste.  It  is  soluble  in  six  parts  of  water,  but  is  in- 
soluble in  alcohol. 

Medical  Properties  and  Action. — The  hypophosphite  of  lime, 
with  those  of  soda  and  potassa,  are  all  included  under  the  term 
"alkaline  sulphites."  Taken  internally,  they  are  readily  ab- 
sorbed, and  are  partially  changed  in  the  system  into  sulphates. 
They  combine  with  acids  to  form  salts,  and  they  dissolve  albu- 
men, and  increase  the  formation  of  saliva.  Being  regarded  as 
tonic,  alterative,  stimulant  and  nervine,  they  are  employed  in 
cases  of  debility,  more  especially  where  the  phosphates  are 
deficient,  as  they  possess  the  therapeutic  properties  of  phos- 
phorus. 

Therapeutic  Uses. — The  different  sulphites  of  lime,  soda,  and 
potassa,  are  employed  in  intermittent  and  malarious  fevers,  typhus 
fever,  smallpox  and  other  exanthematous  diseases,  pyemia,  dys- 
pepsia, neuralgia  with  nervous  depression,  anemia,  for  which 
affections  they  are  combined  with  iron  and  quinine;  diphtheria, 
cystitis,  phthisis,  etc.,  etc.  Externally,  the  sulphites  are  efficient 
as  local  applications  (especially  the  sulphites  of  soda),  in  gangre- 
nous and  other  ulcerations,  diseases  of  the  skin,  etc.  One  or  two 
ounces  to  the  pint  of  water  form  a  stimulant  and  deodorizing 
lotion,  which  is  promotive  of  healthy  action. 


312  DENTAL  MEDICINE. 


Dose. — Of  the  hypophosphites,  gr.  iij  to  gr.  xv,  three  times  a 
day  in  syrup. 

Dental  Uses. — The  hypophosphite  of  lime  is  the  most  eligible 
salt,  but  the  different  sulphites  are  often  administered  together  in 
the  form  of  a  syrup.  Where  there  is  nervous  depression,  as  a 
result  of  trigeminal  neuralgia,  the  hypophosphites  prove  service- 
able. In  the  case  of  delicate  children,  where  there  is  reason  for 
believing  the  phosphate  of  lime,  or  the  lime  salts  generally  of  the 
teeth,  are  deficient  in  quantity. 

CALENDULA. 
MARIGOLD. 

Source. — Calendula  is  a  well-known  garden  plant,  sometimes 
growing  wild,  with  a  peculiar  and  rather  disagreeable  odor,  and  a 
bitter,  rough,  saline  taste.  Both  the  leaves  and  the  flowers  are 
employed. 

Medical  Properties  and  Action. — It  is  slightly  stimulant,  dia- 
phoretic, antispasmodic,  sudorific,  and  emmenagogue,  but  is  sel- 
dom used  internally.  It  contains  a  bitter  principle  known  as 
calenduUn. 

Therapeutic  Uses. — Calendula  has  been  employed  in  low  forms 
of  fevers,  scrofula,  jaundice,  amenorrhea,  etc.  Externally  it  is 
used  in  the  form  of  tincture— Tinctura  Calendula — in  its  full 
strength  or  diluted,  and  is  very  serviceable  in  exercising  a  cura- 
tive influence  in  the  treatment  of  incised  wounds  and  contusions, 
preventing  inflammation  and  suppuration.  Some  writers  consider 
it  to  be  unequaled  as  a  local  application  after  surgical  operations, 
as  it  promotes  union  by  first  intention.  It  is  applied  as  a  lotion 
on  lint.  It  is  also  thought  to  be  a  preventive  against  gangrene 
and  tetanus. 

Dose. — Of  the  tinctura  of  calendula,  f5j  to  f5ij. 

Dental  Uses. — Calendula,  in  the  form  of  tincture,  is  employed 
in  dental  practice  as  an  application  to  wounded  or  irritated  pulps 
of  teeth,  when  partially  exposed;  also  after  the  extraction  of 
teeth  ;  wounds  about  the  mouth ;  and  in  such  cases  it  proves  a 
very  useful  remedy.  A  few  drops  added  to  a  wine-glass  of  water 
form  a  soothing  and  efficient  mouth-wash  for  the  soreness  result- 


CALCIUM.  313 

ing  from  the  removal  of  salivary  calculus  :  also  useful  in  superfi- 
cial inflammations  of  the  mucous  membrane  of  the  mouth,  etc. 

CALX— CALCIUM. 
LIME. 

Formula. — CaO. 

Derivation. — Lime  is  obtained  by  calcining  limestone  or  chalk, 
until  the  carbonic  acid  is  driven  off.  Lime  is  more  soluble  in 
cold  than  in  hot  water,  and  a  compound  of  lime  and  sugar  is 
more  soluble  in  water  than  pure  lime  alone.  Calcium  is  the 
metallic  base  of  lime. 

Medical  Properties  and  Action. — Quicklime  is  a  powerful  escha- 
rotic  and  irritant. 

Liquor  Calcis — Lime  Water. — It  is  prepared  by  adding  cold 
water  to  freshly  slacked  lime,  and  the  clear  fluid  poured  off. 

The  officinal  preparation  consists  of  forty  troy  ounces  of  satu- 
rated solution  of  lime  in  eight  pints  of  distilled  water.  It  is  a 
colorless,  inodorous  liquid,  possessing  a  disagreeable  alkaline  taste. 

Exposure  to  the  air  causes  it  to  gradually  absorb  carbonic  acid, 
with  the  formation  of  insoluble  carbonate  of  lime,  and  it  should 
therefore  be  preserved  in  glass-stoppered  bottles.  The  addition 
of  liquorice  or  coriander  seed  will  disguise  its  taste. 

Medical  Properties  and  Action. — Lime  water  is  antacid,  astrin- 
gent, antiseptic  and  detergent.  It  is  applicable  to  all  cases  where 
antacids  are  indicated,  and  where  an  astringent  effect  is  not 
objectionable. 

Therapeutic  Uses. — Lime  water  is  an  excellent  remedy  in  gastric 
irritation,  accompanied  with  nausea  and  vomiting ;  also  in  dys- 
pepsia, attended  with  vomiting  of  food  ;  also  in  diarrhoea,  after 
the  inflammatory  action  has  been  relieved  ;  also  in  glandular 
affections,  as  an  alterative  resolvent.  Externally,  as  a  wash  for 
foul  ulcers,  diseases  of  the  skin,  and  as  an  injection  in  gleet  and 
leucorrhoea.  Atomized  inhalations  have  been  found  useful  in 
diphtheria  and  membranous  croup. 

Dose. — Of  lime  water,  f^ss  to  f^iij  or  iv,  several  times  a  day. 
It  may  be  mixed  with  an  equal  quantity  of  milk  for  internal  use. 

Lime  Liniment — Linimentum  Calcis  (lime  water  fSviij,  flax- 


314  DENTAL  MEDICINE. 


seed  oil  Svij) — is  a  valuable  application  to  burns,  scalds  and  in 
smallpox. 

Dental  Uses. — In  dental  practice  lime  water  is  a  useful  agent 
in  the  form  of  a  gargle,  where  the  secretions  of  the  mouth  are 
viscid  and  fetid,  and  especially  where  the  teeth  are  soft  in  struc- 
ture and  exceedingly  sensitive,  owing  to  the  condition  of  the  oral 
fluids,  and  especially  in  acrid  mucous  secretions,  which  act  readily 
on  teeth  deficient  in  earthy  constituents.  For  young  patients,  the 
use  of  lime  water  is  very  beneficial  to  the  teeth,  owing  to  an 
acid  condition  of  the  oral  fluids,  common  to  an  early  period 
of  life.  It  is  also  useful  where  the  teeth  are  very  sensitive, 
on  account  of  the  recession  of  the  gum  and  absorption  of  the 
process. 

When  lime  water  is  applied  to  inflamed  mucous  membrane,  or 
to  suppurating  surfaces,  it  arrests  secretion.  It  is  also  useful  in 
sickness  and  irritability  of  the  stomach  during  dentition ;  also  to 
relieve  the  superficial  ulceration  of  the  mucous  membrane  of  the 
mouth,  caused  by  the  acid  eructations  attending  dyspepsia,  in  the 
proportion  of  one  part  of  lime  water  to  two  or  three  of  milk. 

Syrup  of  the  Lacto-phosphate  of  Lime. — Syrupus  Calcii 
Lacto-phosphatis — is  composed  of  precipitated  phosphate  of  cal- 
cium, 22  parts ;  lactic  acid,  33  parts ;  orange-flower  water,  80 
parts;  sugar,  600  parts;  hydrochloric  acid,  water  of  ammonia 
and  water,  each,  a  sufficient  quantity. 

Dose. — f5j  to  fSj. 

This  syrup  is  especially  useful  in  rickets,  mollities  ossium, 
delayed  union  of  fractures,  caries  and  necrosis  in  bone,  anemia 
of  nursing  mothers,  mammary  abscesses  or  boils,  carbuncles, 
chronic  bronchitis,  leucorrhcea,  early  decay  in  the  teeth  in  chil- 
dren, etc. 

CALX  CHLORATA— CHLORINATED  LIME. 
CHLORIDE    OF    LIME. 

Formula. — CaCUO. 

Derivation. — Chloride  of  Lime  is  obtained  by  passing  chlo- 
rine over  hydrate  of  lime  till  saturation  is  effected.  It  is  in  the 
form  of  a  grayish-white   substance,  either  in   powder  or  friable 


CHLORIDE  OF  LIME.  315 


masses,  dry  or  but  slightly  moist.  It  is  readily  soluble  in  water, 
and  will  absorb  moisture  when  exposed  to  the  air.  It  has  a  bit- 
ter, caustic  taste,  and  a  slight  odor  of  chlorine. 

Medical  Properties  and  Action. — Chloride  of  lime  is  a  stimulant, 
deodorizer,  disinfectant,  antiseptic  and  bleaching  agent.  In 
small  doses  it  increases  the  action  of  the  secreting  organs,  and  if 
long  continued  it  acts  specifically  upon  the  lymphatic  glandular 
system,  causing  the  reduction  or  absorption  of  glandular  and 
other  tumors.  In  large  doses  it  acts  as  an  acro-narcotic  poison, 
and  its  use  should  always  be  commenced  in  small  doses,  carefully 
increased,  and  discontinued  when  such  symptoms  as  nausea, 
vomiting  or  giddiness  appear.     It  is  chiefly  used  as  a  disinfectant. 

Therapeutic  Uses. — Solutions  of  chlorinated  lime  are  employed 
locally  in  scarlet  fever,  diphtheria,  aphthae,  gangrene ;  and  it  has 
been  administered  internally  in  scrofula,  typhus,  malignant  scar- 
let fever,  syphilis,  etc. 

Dose. — Of  chloride  of  lime,  gr.  j  to  gr.  v,  in  solution,  several 
times  a  day.     As  a  wash,  i  part  dissolved  in  lOO  parts  of  water. 

Dental  Uses. — Chloride  of  lime  is  employed  in  dental  practice 
in  the  treatment  of  cancrum  oris  ;  one  method  of  application 
being  the  introduction  of  the  dry  powder,  with  the  point  of  the 
finger,  to  the  ulcerated  surfaces,  and  the  mouth  well  washed  out 
immediatelv  afterward  ;  also,  in  the  form  of  a  gargle  composed 
of  I  part  of  powdered  chloride  of  lime  to  30  parts  of  mucilage 
and  15  parts  of  syrup.  Solutions  of  chloride  of  lime  are  also 
efficient  in  scorbutic  and  other  ulcerations  of  the  mouth.  It  is 
also  employed  to  correct  the  fetor  of  the  breath,  in  the  form  of  a 
mouth  wash,  prepared  as  a  weak  solution. 

One  of  the  most  important  uses  in  dental  practice  is  as  a 
bleaching  agent,  either  alone  or  in  combination  with  other  sub- 
stances, to  restore  the  color  of  devitalized  teeth.  When  chlori- 
nated lime  is  employed  for  bleaching  discolored  teeth,  a  good 
quality  should  be  obtained,  and  no  steel  instrument  used  for  its 
introduction  ;  wood  or  gold  instruments  are  to  be  preferred,  and 
the  chloride  should  be  perfectly  dry,  and  have  been  kept  so  from 
the  time  it  was  made.  An  efficient  bleaching  preparation  is  com- 
posed   of  equal   parts   of  dry  chlorinated   lime  and  tartaric  acid. 


316  DENTAL  MEDICINE. 


mixing  them  together  dry,  and  adding  a  little  of  the  acid  at  a 
time.  When  prepared,  the  mixture  should  be  kept  in  a  glass- 
stoppered  bottle.  For  bleaching  purposes,  chlorinated  lime  is 
also  combined  with  chloroform,  in  the  form  of  a  thin  paste. 
When  chlorinated  lime,  or  its  combinations,  is  introduced  into 
the  cavity  of  a  tooth,  it  should  be  secured  by  a  temporary  filling 
of  gutta  percha.  Hill's  Stopping,  or  one  of  the  zinc  preparations, 
and  be  secured  from  passing  beyond  the  foramen  of  the  root,  by 
a  filling  introduced  near  the  apex  of  the  root.  More  than  one 
application  may  be  required,  after  which  the  cavity  should  be 
thoroughly  cleansed,  and  a  temporary  filling  of  the  whitest  shade 
of  the  oxychloride  of  zinc  filling  material  be  introduced  and 
worn  for  some  time,  after  which  a  more  durable  gold  filling  can 
be  inserted. 

DENTAL    FORMULAE. 
For    Gangrene  of  the  Mouth —  Can-  For  Fetor  of  the  Breath, 

crum  Oris.  Bartholow. 


Bartholow. 


R.     Calc.  chlorat ^iij 

Aquae  destil ^  ij 

R.     Calc.  chlorat gss  Alcoholis ^ij 

Mucilaginis |ss  Qi.  rosse gtt.iv.    M. 

Aquae  destil giiiss.  M.       SlGNA.-^A  teaspooriful  in  a  tumblerful 

SiGNA. — To  be  used  as  a  lotion.  of  water ;  used  as  a  gargje. 

CAMPHO-PHENIQUE. 

Formula. — CgHnO. 

Derivation. — A  limpid,  volatile  fluid  with  a  hot,  aromatic  taste, 
and  the  odor  of  camphor,  obtained  from  the  chemical  union  of 
carbolic  acid  and  camphor.  Dissolve  9  parts  of  the  acid  in  one 
part  of  alcohol  and  mix  with  25  parts  of  camphor,  forming  a 
clear  oily  solution.  Campho-phenique  can  be  prepared  by  heating 
carbolic  acid  and  pouring  it  into  a  bottle  containing  camphor-gum. 

Medical  Properties  and  Therapeutic  Uses. — Campho-phenique  is 
an  antiseptic,  local  anaesthetic,  germicide  and  parasiticide.  It  is 
also  non-irritant,  non-poisonous,  insoluble  in  water  or  glycerine, 
does  not  discolor  or  stain,  and  possesses  an  agreeable  odor  and 
taste.  It  prevents  suppuration  in  fresh  wounds,  controls  it  in 
wounds  in  all  stages,  and  as  a  local  anaesthetic  obtunds  pain.     It 


CAMPHO-PHENIQUE.  317 


is  claimed  that  campho-phenique,  pure,  is  equal  to  i  to  85  of 
bichloride  of  mercury  which  is  six  times  as  strong  as  it  can  be 
used  even  on  the  unbroken  skin,  and  about  25  times  as  strong  as 
is  considered  safe  on  cut  surfaces.  Campho-phenique  is  alto- 
gether free  from  toxic  or  caustic  properties,  and  is  one  of  the 
safest  of  germicides  ;  it  also  maintains  an  unchanged  integrity, 
and  is  well  adapted  to  a  large  proportion  of  pathological  dental 
cases.  It  should  never  be  combined  with  water  or  glycerin,  but 
it  will  mix  in  all  proportions  with  alcohol,  ether,  chloroform,  and 
all  fatty  substances. 

Employed  as  an  antiseptic,  it  penetrates  the  tissues  as  rapidly  as 
carbolic  acid,  and  also  slightly  hardens  them. 

Dental  Uses. — As  a  pulp-canal  dressing,  campho-phenique  has 
given  very  satisfactory  results  as  a  substitute  for  corrosive  subli- 
mate, carbolic  acid,  creasote,  oil  of  cloves,  iodoform,  etc.  If 
thoroughly  applied  to  the  gum  or  injected  with  a  hypodermic 
syringe,  it  acts  as  an  efficient  local  anaesthetic,  and  causes  no 
constitutional  disturbance.  It  is  also  employed  as  an  obtunder 
of  sensitive  dentine,  and  relieves  the  pain  following  the  extrac- 
tion of  abscessed  teeth  when  applied  on  a  pledget  of  cotton  :  it 
also  relieves  the  pain  attending  the  separation  of  teeth,  and  irrita- 
tion of  the  dental  pulp.  It  is  also  used  as  the  menstruum  for  the 
arsenic  and  morphia  of  pulp  devitalizing  preparations  :  also  for 
putrescent  pulps,  and  as  an  antiphlogistic  in  the  earlier  stages  of 
periodontitis.  It  will  mitigate  the  pain  attending  the  induction 
of  suppuration,  and  either  in  full  strength  or  diluted,  give  satis- 
factory results  when  injected  into  fistulas.  It  is  also  useful  as  an 
antiphlogistic  in  the  earlier  stages  of  sthenic  pericementitis  ap- 
plied to  the  gum  on  small  pads  of  linen  and  renewed.  Also 
useful  in  eczema,  intolerable  itchings,  burns,  sprains,  etc. 

DENTAL    FORMULAE. 


For  Chapped  Phuids. 

Campho-phenique 

Dentifrice, 

].  W.  Downey,  M.  D. 

B. 

Campho-phenique 

.    .    .       4  parts 

R.    Campho-phenique  .    .  aa^j 

Myrrh 

.    .    .       2  parts 

Oil  of  Amygd.  Amarse  .  TTL'U 

Cuttle-fish  bone  . 

.    .           4  parts 

Rose  cosmolene    .    .    .  ^j.        M. 

Prepared  chalk  . 

.    .    .     16  parts 

SiGNA. — Apply  frequently. 

Lake  or  rose  pink 

.    .    .        I  part. 

318  DENTAL  MEDICINE. 


CAMPHORA— CAMPHOR. 

Formula. — C,|jH,gO. 

Source. — Camphor  is  a  concentrated  substance  obtained  from 
the  camphor  laurel,  an  evergreen  tree  of  China,  Japan  and  For- 
mosa, by  sublimation,  the  crude  gum  being  purified  by  resublima- 
tion  with  quicklime.  Refined  camphor  is  in  the  form  of  large 
circular  cakes,  one  or  two  inches  thick,  and  has  a  strong,  pene- 
trating, fragrant  odor,  and  a  bitter,  pungent  taste,  attended  with  a 
slight  sense  of  coolness.  It  is  white,  pellucid,  and  somewhat  unc- 
tuous to  the  touch. 

Medical  Properties  and  Action. — Camphor  is  anodyne,  stimulant, 
refrigerant,  diuretic  and  diaphoretic.  It  increases  the  action  of 
the  heart  and  arteries,  and  renders  the  pulse  softer  and  fuller ;  but 
such  effects  are  very  transitory,  and  are  followed  by  depression. 
In  large,  but  not  over-doses,  it  allays  pain  and  spasm,  and  induces 
sleep.  In  over-doses,  it  excites  narcotic  symptoms,  with  those  of 
an  irritant  poison,  and  has  proved  fatal.  It  acts  chiefly  on  the 
nervous  system. 

Therapeutic  Usrs. — Camphor  is  administered  in  fevers  of  an 
asthenic  type,  acute  inflammations,  inflammation  of  the  brain, 
delirium  tremens,  asthma,  rheumatic  and  nervous  headaches,  dis- 
eases of  the  heart,  hysteria,  dysentery,  diarrhoea,  cholera,  etc.,  etc. 
Externally  as  an  anodyne  in  rheumatism,  and  as  a  discutient  in 
chronic  inflammatory  affections  ;  also,  the  powder  as  a  snuff  in 
coryza  and  influenza,  and  in  the  form  of  Camphor  Liniment — 
Linimentum  Camphor  a — (camphor  I  part,  olive  oil  4  parts). 

Camphor  Water, — Aqua  Camphora — (camphor  gr.  cxx, 
alcohol  TTtxl,  carbonate  of  magnesia  oss,  distilled  water  Oij). 

Soap  Liniment- — Linimentum  Saponis — (camphor  .5iv,  oil  of 
rosemary  fSss,  alcohol  Oij,  water  .5vj)  is  an  anodyne  and  gentle 
rubefacient  for  sprains,  rheumatic  and  gouty  pains. 

Spirit  of  Camphor — Spiritus  Camphor ce — (camphor  5iv,  alco- 
hol Oij). 

Dose. — Of  camphor  in  substance,  gr.  ij  to  gr.  x,  in  form  of  an 
emulsion,  made  of  sugar,  gum  arabic,  myrrh  and  water.  Of 
camphor  water  5j  to  ,3j ;  of  spirit  of  camphor,  Hlv  to  TTLxx. 

Dental  Uses. — In  dental  practice,  the  spirit  of  camphor  is  locally 


CAMPHOR.  319 


employed  to  allay  the  pain  arising  from  the  near  exposure  of  the 
pulps  of  teeth  ;  also  the  pain  of  sensitive  dentine,  and  that  follow- 
ing the  extraction  of  teeth  affected  with  periodontitis ;  also  to  ar- 
rest the  hemorrhage  and  allay  the  pain  of  wounded  pulps  of  teeth. 
It  forms  an  efficient  anodyne  when  in  the  form  of  a  strong  solu- 
tion of  camphor  in  chloroform.  Camphor  has  also  been  employed 
in  the  treatment  of  putrescent  pulps  of  teeth. 

Combined  with  creasote  or  carbolic  acid,  camphor  is  thought  to 
have  the  power  of  modifying  the  escharotic  action  of  these  agents. 
For  such  a  purpose,  20  grains  of  camphor  are  combined  with  i 
ounce  of  the  creasote  on  carbolic  acid. 

The  Oil  of  Camphor. —  Oleum  Camphone  is  preferred  by 
some  to  answer  such  indications.  Camphor  also  forms  one  of 
the  ingredients  of  the  celluloid  base  of  artificial  teeth,  which  is 
composed  of  pyroxylin  lOO  parts,  camphor  40  parts,  oxide  of  zinc 
2  parts,  and  vermilion  0.6  part.  With  ether,  camphor  is  also 
used  as  a  local  anaesthetic.  A  cataplasm  of  camphor,  morphia  and 
flaxseed,  applied  to  the  cheek,  has  been  used  for  the  relief  of 
odontalgia. 

Phenol-Camphor  is  made  by  mixing  together  i  part  of  carbolic 
acid  and  3  parts  of  camphor.  After  24  hours  this  becomes  a 
liquid,  having  a  specific  gravity  of  990.  It  is  used  with  oil  as  an 
antiseptic,  and  in  the  form  of  spray  may  be  applied  to  the  skin  as 
a  local  anaesthetic.  It  is  also  employed  to  disinfect  or  sterilize 
surgical  and  dental  instruments,  and  on  wool  and  gauze  for  dress- 
ing wounds.  It  is  soluble  in  ether,  alcohol  and  oils,  but  insolu- 
ble in  water  or  glycerin.  Menthol,  cocaine,  salicylic  acid,  iodo- 
form, chloral  hydrate  and  mercuric  chloride  are  soluble  in  phenol- 
camphor.      (See  Campho-Phenique.) 

Camphoid  is  composed  of  camphor  20  parts,  alcohol  20  parts, 
and  pyroxylin  i  part. 

Carbolated  Camphor  is  composed  of  carbolic  acid  (crystal)  49^ 
parts  and  gum  camphor  503^  parts. 

Nausea  from  Impression  Taking. — Dr.  A.  W.  McCandless  rec- 
ommends a  gargle  of  camphor  water.  Should  this  fail,  a  four  per 
cent,  solution  of  cocaine  painted  over  surface  of  the  tongue  and 
palate  will  produce  the  desired  result  except  in    very  obstinate 


320  DENTAL  MEDICINE. 

cases ;  or  a  lozenge  composed  of  one-fourth  grain  of  cocaine 
allowed  to  dissolve  in  the  mouth  and  swallowed  before  taking  the 
impression. 

DENTAL    FORMULA. 

For  a  Local  Anasthetic.  For  a  Local  Anasthetic, 

R.     Pulv.  camphorce  .    .    .  .^viij  li.    Camphoia.- ^j 

i^Lther  sulph f^^j.      M.  .'lilher  vel  chlorofoimi  .  ^ij.      M. 

r,      ..        .      ,.  j»     ^u  »u         SiGNA. — Apply     with    a    camel's-hair 

SiGNA. — Applied  to  the  gum  over  the  ^^  ■' 

tooth  to  be    removed,  until  it  turns 

white  or  becomes  blanched.  For  Xeuralgia, 

R  •     CamphorjE, 
For  a  Local  Amesthetic.  ^,  ,       t.   j    .■    --  i        .     nr 

Chlor.  hydratis  aa  equal  parts.  M. 
R .     Chloral, 

n        y  --  _•  SiGNA. — Apply  as  a  lotion. 

Camphorae        .    .    .  aa^J.  '^'^  ^ 

Morphise  sulph.  .    .       gss  For  Neuralgia  and  Exposed  Pulps. 

Chloroformi .  .    .    .       ^  j.        M.       r»       ^        , 

»'•'  R.     Camphorae 5  parts 

SiGNA.— Apply    with    a    camel's-hair  Chlor.  hydratis   ...  2  parts 

brush,  allow  to  dry  and  re-apply  as  Cocaine  hydrochlor.  .  i  part.   M. 

freely  as  is  necessary  to  render  part  Signa. — Heat  to  boiling  point  of  water, 

insensible  to  pain.  when    it    liquifies ;  use    as    a  local 

application. 
For  a  Stimulant  and  Anodyne  Lotion. 

R.     Spiritus  Rosmarini  .    .  ^j  ^"^  ^«'«  "f  ^'ooth  Extraction. 

Camphorae ^[j  R.    Camphorae ^j 

Saponisalbse     .    .    .    .  ^iv.  M.  Chloroformi f^U-      M. 

SiGNA. — To  be  applied  as  a  lotion.  Signa. — Apply  on  cotton. 

For  Odontalgia. 

R .         Camphorae, 

Chloral  hydrat iia  gr.  75 

Cocaine  hydrochlorat gr.  xv.  M. 

Signa. — Place  a  small  quantity  on  cotton  within  the  cavity, 

CAMPHORA  MONOBROMATA— MONOBROMATED  CAMPHOR. 

Formula. — CiyHijBrOg. 

Derivation. — Monobromated  camphor  is  obtained  by  the  action 
of  bromine  on  camphor,  and  subsequent  purification  with  animal 
charcoal  and  repeated  crystallization.  It  is  a  colorless,  crystal- 
line substance,  with  the  odor  of  camphor  and  turpentine,  and  a 
slightly  bitter  taste.  It  is  insoluble  in  water,  but  soluble  in  alco- 
hol and  ether. 

Medical  Properties  and  Action. — It  produces  a  sedative  effect 


CAPSICUM.  321 


upon  the  circulatory  system,  and   especially  upon  the  cerebro- 
spinal nervous  system,  and  is  also  an  antispasmodic. 

Therapeutic  Uses. — Bromide  of  camphor  is  employed  as  a  seda- 
tive and  antispasmodic,  in  affections  of  the  nervous  system,  and 
where  camphor  is  indicated,  as  in  asthma,  neuralgia,  hysteria,  de- 
lirium tremens,  etc. 

Dose. — Of  bromide  of  camphor,  gr.  ij  to  gr.  x,  for  an  adult. 
Dental  Uses. — In  dental  practice  the  bromide  of  camphor  is 
employed  as  a  sedative  in  convulsions  of  dentition,  neuralgia,  etc. 
For  children  suffering  from  the  convulsions  of  dentition,  gr.  j  of 
the  bromide  of  camphor  in  acacia  mucilage,  and  administered 
every  hour,  has  been  very  serviceable  in  arresting  the  paroxysms. 

CAPSICUM. 
CAYENNE    PEPPER. 

Source. — Capsicum  is  obtained  from  the  tropics  of  both  hemi- 
spheres, being  the  fruit  of  capsicum  annuum,  and  of  other  species 
of  capsicum.  The  crimson  or  yellow  pods  are  dried  and  ground 
to  powder,  which  has  a  bright  red  color,  and  an  aromatic  smell, 
with  a  bitter,  acrid,  burning  taste.  Its  acrid,  pungent  qualities 
are  due  to  a  peculiar  substance  in  the  form  of  a  thick,  yellowish- 
red  fluid,  called  capsicine. 

Medical  Properties  and  Action. — Capsicum  is  a  powerful  stimu- 
lant, producing,  when  small  doses  are  taken,  a  sensation  of 
warmth  in  the  stomach,  and  a  general  glow  over  the  body.  It 
promotes  the  digestive  process,  and  stimulates  the  circulation, 
and  also  the  genito-urinary  organs.  In  excessive  doses,  capsicum 
is  an  irritant  poison. 

Therapeutic  Uses. — It  is  employed  in  certain  forms  of  dys- 
pepsia, flatulent  colic,  scarlet  fever,  yellow  fever,  delirium 
tremens,  opium  habit,  etc.,  etc.  Externally  or  locally  as  a 
gargle,  in  putrid  or  other  forms  of  sore  throat,  chronic  inflamma- 
tion of  the  fauces,  hoarseness  due  to  relaxed  condition  of  the 
vocal  cords,  relaxed  uvula,  and  in  poisoning  by  opium,  belladonna 
and  aconite,  it  has  proved  useful  as  a  stimulant. 

Dose. — Of  powdered  capsicum,  gr,  v  to  gr.  x,  in  pill.  Of  the 
tincture  of  capsicum — Tinctura  Capsici  (capsicum  5j,  to  diluted 
21 


322  DENTAL  MEDICINE. 


alcohol,  Oij — the  dose  is  Hlx  to  f  5j)-  Of  the  infusion — Infusum 
Capsici  (capsicum  5ss ;  boiling  water  Oj) — the  dose  is  f  5ss. 
The  infusion  is  also  used  as  a  gargle. 

Dental  Uses. — In  dental  practice  the  tincture  of  capsicum  is 
serviceable  in  the  early  stages  of  acute  periodontitis;  and  also 
where  it  is  necessary  to  hasten  suppuration  as  quickly  as  possible, 
on  account  of  the  increasing  severity  of  the  attack — a  solution 
composed  of  gtt.  xxv,  in  a  glass  of  warm  water,  of  which  a 
mouthful  is  to  be  retained  for  some  minutes. 

The  tincture  of  capsicum  is  also  useful  in  chronic  dental 
periodontitis,  to  resolve  the  inflammatory  products.  It  is  also 
used  to  stimulate  the  gums  and  mucous  membrane  of  the  mouth 
in  chronic  inflammation  and  ulceration,  and  for  looseness  of  the 
teeth  as  a  result  of  salivation ;  also  in  cases  of  turgidity  and 
puffiness  of  the  gums.  It  is  often  serviceable  in  chronic  alveolar 
abscess  as  an  injection,  after  the  sac  has  been  destroyed,  also  in 
recession  of  the  gums  from  the  necks  of  the  teeth,  for  the  pur- 
pose of  stimulating  them.  A  few  drops  added  to  a  solution  of 
aromatic  sulphuric  acid  will  prove  serviceable  in  caries  of  the 
maxillary  bones,  and  in  disease  of  the  antrum.  An  efficacious 
stimulant  gargle  may  be  made  of  the  tincture  of  capsicum  5ss. 
to  rose  water  oviij.  Dr.  Kirk  recommends  capsicum  as  a  local 
stimulant  and  counter-irritant  in  the  initial  stages  of  pericemental 
inflammation  before  the  formation  of  pus  has  taken  place ;  in 
cases  of  soreness  about  roots  of  pulpless  teeth,  due  to  external 
violence,  cold,  etc.,  and  not  to  septic  irritation  ;  for  relief  of 
severe  neuralgias  following  the  extraction  of  lower  molar  teeth, 
in  the  form  of  a  cataplasm  applied  to  the  affected  side  of  the 
face,  or  by  moistening  a  piece  of  heavy  blotting  paper  and  apply- 
ing this  to  the  side  of  face.  Dr.  J.  F.  Flagg  recommends  the 
use  of  capsicum  for  pericemental  inflammation  in  the  form  of 
the  powder  sewed  in  small  linen  bags  to  be  placed  in  the  mouth 
over  root  of  affected  tooth.  Dr.  Leffmann  recommends  small 
oval  disks  cut  from  capsicum  plaster  (Seabury  &  Johnson's),  the 
surface  of  which  has  been  lightly  anointed  with  the  ethereal  ex- 
tract, or  oleoresin  of  capsicum,  which  can  be  nicely  adapted  to 
the  eum. 


PURIFIED  ANIMAL  CHARCOAL.  323 


CARBO  ANIMALIS  PURIFICATUS— PURIFIED  ANIMAL 
CHARCOAL. 

Source. — Animal  Charcoal,  called  "  bone  black,"  is  obtained  by 
exposing  bones  to  a  red  heat,  protected  from  the  air.  It  consists 
of  charcoal,  phosphate  and  carbonate  of  lime. 

Purified  Animal  Charcoal. — Carbo  Animalis  Purificatus — 
is  obtained  by  digesting  bone-black  in  hydrochloric  acid  and 
water  to  a  moderate  heat,  when  it  is  dried  and  heated  to  redness 
in  a  covered  crucible. 

Properties  and  Action, — Animal  charcoal  is  an  absorbent,  and  is 
used  to  counteract  the  effects  of  poisonous  agents,  such  as  the 
alkaloids  and  acids. 

Dose. — Of  animal  charcoal  as  an  absorbent,  .5ss,  to  neutralize 
the  effects  of  each  grain  of  such  agents  as  strychnia  and 
morphia. 

CARBO  LIGNI— WOOD  CHARCOAL. 

Source. — Wood  Charcoal  is  obtained  by  subjecting  soft  wood 
to  a  red  heat  with  but  a  limited  supply  of  air,  by  which  the 
water,  etc.,  are  removed,  allowing  the  carbon  to  remain. 

Properties  and  Action. — Wood  charcoal  is  antiseptic  and  disin- 
fectant and  detergent,  and  is  very  serviceable  in  correcting  the 
fetor  of  discharges  and  arresting  the  process  of  ulceration, 
especially  when  in  the  form  of  the  dry  powder,  or  mixed  with 
linseed  as  a  poultice. 

Therapeutic  Uses. — For  foul  and  gangrenous  ulcers,  gangrene, 
phagedaena,  suppurating  surfaces,  cancerous  tumors,  etc.,  etc. 

Dental  Uses. — The  powdered  charcoal  added  to  water,  in  the 
proportion  of  one  or  two  drachms  to  a  glass  of  water,  forms  an 
efficient  disinfectant  gargle  for  the  offensive  fetor  of  mercurial 
stomatitis ;  also  useful  in  foul  and  gangrenous  ulcers  of  the 
mouth,  diseased  gums,  offensive  ulcerations,  offensive  fetor  of 
cancrum  oris,  etc.,  etc.  Notwithstanding  its  detergent  prop- 
erties, injury  results  from  its  use  as  a  dentifrice,  on  account  of 
its  tendency  to  cause  recession  of  the  gums  from  the  necks  of 
the  teeth. 


32J:  DENTAL  MEDICINE. 


CARVACROL. 


Formula. — CjqHjjOH. 


Source. — The  caraway  plant,  a  native  of  Europe. 

Derivation. — Carvacrol  is  a  product  of  the  essential  oil  of 
caraway,  which  is  obtained  from  the  seeds  of  the  plant.  Cara- 
way— carum — seeds  are  of  a  light  yellow  color,  with  a  pleasant 
aromatic  smell,  and  a  sweetish,  warm,  spicy  taste.  They  are 
stomachic  and  carminative,  and  are  occasionally  used  in  flatulent 
colic,  as  a  corrective  of  other  medicines.  The  volatile  oil  of 
caraway  is  most  employed  in  doses  of  gtt.  j  to  gtt.  x.  Carva- 
crol is  obtained  by  treating  the  oil  of  caraway  with  iodine,  and 
washing  the  product  with  potassa,  when  it  is  mixed  with  carvene, 
which  is  one  of  the  liquid  oils  of  caraway.  Carvacrol  is  also 
found  among  the  products  of  the  action  of  iodine  on  camphor. 
When  pure,  it  is  a  colorless,  viscid  oil,  lighter  than  water,  in 
which  it  is  nearly  insoluble.  Its  odor  is  like  that  of  creasote, 
and  its  taste  is  persistent,  strong  and  acrid. 

Medical  Properties  and  Action. — Carvacrol  is  antiseptic,  carmi- 
native, disinfectant  and  escharotic.  Combined,  it  forms  an  effi- 
cient gargle  in  inflammatory  conditions.  It  is  not  employed  inter- 
nally. 

Dental  uses. — In  dental  practice,  carvacrol  has  been  employed 
as  a  substitute  for  creasote,  carbolic  acid  and  glycerole  of  thymol, 
in  the  treatment  of  odontalgia,  sensitive  dentine,  alveolar  abscess, 
and  as  an  antiseptic  in  the  pulp  canals  of  teeth ;  also  as  a  gargle 
in  inflamed  and  ulcerated  conditions  of  the  mucous  membrane  of 
the  mouth,  tonsilitis,  etc.  Combined  with  water,  in  the  propor- 
tion of  3  drops  to  the  ounce,  it  forms  an  efficient  gargle  in  stom- 
atitis, tonsilitis,  etc.;  the  strength  of  the  solution  may  be  in- 
creased, when  a  more  powerful  action  is  required.  It  is  also  em- 
ployed with  advantage  in  sensitive  cavities  of  the  teeth,  in  oper- 
ating with  the  dental  engine,  to  lessen  the  pain  from  friction  of 
the  instrument.  As  an  application  in  odontalgia,  from  an  exposed 
and  irritable  pulp,  it  affords  almost  instantaneous  relief.  It  is 
claimed  for  carvacrol,  that  it  is  not  so  liable  to  cause  inflammation 
as  creasote;  especially  when  it  is  applied  through  the  pulp  canals. 


CATECHU.  325 

When  employed  to  obtund  the  sensitiveness  of  dentine,  it  is 
necessary  to  confine  it  in  the  cavity  of  the  tooth  for  a  few  days, 
by  means  of  a  temporary  filling  of  zinc  preparation,  as  it  readily 
dissolves  Hill's  Stopping  and  gutta  percha.  When  it  is  used  in 
the  form  of  an  injection  in  alveolar  abscess,  a  sharp,  burning  sen- 
sation is  experienced  as  soon  as  it  reaches  the  seat  of  the  affec- 
tion, when  the  crown  cavity  of  the  tooth  should  be  immediately 
closed. 

In  patients  of  a  scrofulous  diathesis,  it  is  necessary  to  exercise 
care  in  the  use  of  carvacrol.  When  applied  to  cavities  before  the 
introduction  of  the  filling,  and  to  exposed  pulps,  it  is  introduced 
on  a  pellet  of  cotton. 

CATECHU -CATECHU. 

Source. — Catechu  is  obtained  from  the  Acacia  catechu,  a  large 
tree  of  Pegu,  and  is  in  the  form  of  large,  hard,  and  brittle  masses, 
porous  on  fracture,  and  possessing  a  strong  astringent  and  sweet- 
ish taste. 

Medical  Properties  and  Therapeutic  Uses. — Catechu  is  a  valuable 
astringent,  and  is  frequently  employed  in  diarrhoeas  of  relaxation, 
and  locally  in  gonorrhoea  or  leucorrhoea  in  the  form  of  injections. 

Dose. — Gr.  j  to  xxx. 

Tinctura  Catechu  Composita. — Compound  Tincture  of  Catechu 
(catechu,  12;  cinnamon,  8,  in  diluted  alcohol,  q.  s.  ad.  lOO 
parts). 

Dose. — Trixf5j. 

Dental  Uses. — Catechu  is  a  valuable  local  astringent  in  the 
form  of  a  mouth  wash  for  spongy  gums,  and  relaxed  condition  of 
the  oral  mucous  membrane. 

DENTAL    FORMULA. 

J^or  Hemorrhage  after  Extraction  of  Teeth. 

Dr.  D.  a.  Rosenthal. 

(For  Internal  Administration.) 

R.         Tinct.  catechu f^j 

Tinct.  digitalis f^iss 

Extr.  ergota;  fl q.  s.  ad.  f^ij.        M. 

SiGNA. — A  dessertspoonful    every  2  hours. 


326  DENTAL  MEDICINE. 


CRINOLINE  OR  QUINOLINE. 

Formula. — CgH^N. 

Derivation. — Chinoline  was  first  obtained  from  coal  tar,  but 
afterward-  from  the  cinchona  alkaloids.  More  recently  it  has 
been  produced  by  the  action  of  glycerin  on  aniline,  or  nitro-ben- 
zol.  It  is  an  oily  liquid,  with  highly  refracting  property,  and  it 
combines  with  acids  to  form  salts.  The  salt.  Tartrate  of  Chino- 
line., is  not  so  deliquescent  as  the  other  salts  formed  by  its  com- 
bination with  acids,  and  is  in  the  form  of  lustrous  crystals,  which 
preserve  their  form  even  in  a  damp  atmosphere,  although  they 
are  soluble  in  water.  Chinoline  is  very  soluble  in  alcohol,  and 
sparingly  soluble  in  water. 

Medical  Properties  and  Action. — Chinoline,  like  other  phenol 
derivatives,  such  as  resorcin,  hydroquinone,  etc.,  possesses  the 
power  to  lower  fever  heat,  but  does  not  affect  the  normal  tem- 
perature. 

Therapeutic  Uses. — Like  resorcin,  chinoline  has  been  used  in 
intermittent  and  remittent  fevers  with  great  success ;  also  in  sep- 
tic disorders.  Topically,  chinoline  is  a  valuable  antiseptic,  and 
successfully  acts  upon  minute  organisms,  preventing  their  increase 
and  septic  decomposition.  A  five  per  cent,  solution  of  the  tar- 
trate of  chinoline,  the  salt  generally  employed,  has  been  applied 
locally  in  diphtheria,  with  marked  effect. 

Dose. — Of  chinoline,  gr.  v  to  xv. 

Dental  Uses. — Chinoline  is  used  in  dental  practice  as  an  anti- 
septic, belonging  to  the  same  class  as  resorcin,  the  salt  tartrate  of 
chinolin,  in  the  form  of  a  five  per  cent,  solution,  being  preferable 
for  local  application.  It  is  also  used  in  combination  with  car- 
bolic acid,  for  application  on  cotton  to  an  aching  cavity  from 
which  a  tooth  has  been  extracted. 


CHLORIDE  OF  ALUMINIUM— ALUMINII  CHLORIDIUM— 
CHLORALUM. 

Formula. — Al2Clg. 

The  chloride  of  aluminium,  also  known  as  Chloralum.,  is  pre- 
pared  by  passing  chlorine,  at   high  temperatures,  over  a   mixture 


CHLORIDE  OF  MAGNESIA.  327 

of  aluminium  and  charcoal.  By  placing  the  anhydrou  chlorides 
of  aluminium  in  water,  it  is  converted  into  hydrated  chloride.  It 
is  said  to  be  quite  as  potent  as  chloride  of  zinc  or  carbolic  acid, 
and  devoid  of  poisonous  properties  and  unpleasant  odor,  and  is 
unirritating,  rendering  it  a  useful  antiseptic  and  disinfectant.  As 
it  does  not  cauterize,  it  is  especially  convenient  for  applications 
to  the  mouth.  The  taste  is  sharply  saline,  like  that  of  alum,  and 
its  action  closely  approximates  that  of  chloride  of  zinc. 

In  dental  practice  it  has  been  used  in  the  treatment  of  peri- 
odontitis, alveolar  abscess,  caries  of  bones,  putrid  pulps,  alveolar 
pyorrhoea,  and  other  diseases  of  mucous  membrane. 


CHLORIDE  OF  MAGNESIA— MAGNESII  CHLORIDUM. 

Formula.— MgCl^-j-  2Na. 

Chloride  of  Magnesia  is  prepared  by  evaporating  to  dryness  a 
concentrated  solution  of  muriate  of  magnesia,  the  chloride  being 
obtained  in  the  state  of  a  fused  hydrate.  It  is  a  bitter,  very 
deliquescent  salt,  vi^hich  acts  mildly  and  favorably  as  a  purgative, 
causing  a  flow  of  bile,  and  an  increase  of  appetite.  On  account 
of  its  extreme  deliquescence  the  liquid  form,  prepared  by  dis- 
solving the  salt  in  its  weight  of  water,  is  preferred.  The  dose, 
diluted,  is  .^ss  to  .^j.  In  dental  practice  the  chloride  and  hypo- 
chlorite of  magnesia  have  been  employed  for  bleaching  teeth. 

CHLORIDE  OF  TIN— STANNUM  CHLORIDIUM. 

Formula, — SnCl2. 

Chloride  of  tin  is  prepared  by  heating  tin  and  hydrochloric 
acid  together,  and  has  been  recommended  for  local  application  in 
purulent  discharges.  According  to  M.  Mallez,  chloride  of  tin 
has  a  direct  action  upon  purulent  secretions  from  mucous 
surfaces,  without  any  substitutive  action,  like  nitrate  of  silver 
for  instance.  Placed  in  contact  with  pus  globules,  under  the 
microscope,  these  are  seen  to  immediately  disappear.  In  purulent 
diseases  of  the  eye,  also  it  was  successful.  A  solution,  consisting 
of  3ss  of  the  salt  in  fsiij  of  distilled  water,  is  used  for  injections. 


328  DENTAL  MEDICINE. 


CHLORIDE  OF  METHYL— METHYL  CHLORIDE. 

Formula. — CH3CI. 

Derivation. — Chloride  of  Methyl  is  produced  by  the  action  of 
chlorine  upon  marsh  gas ;  by  heating  together  common  salt, 
sulphuric  acid  and  methyl  alcohol  -,  or  it  is  more  cheaply  manu- 
factured by  using  the  waste  products  of  beets  used  in  the  manu- 
facture of  sugar.  It  is  the  chloride  of  a  hydrocarbon  in  the  form 
of  methyl  chloride,  and  resembles  ether  in  appearance,  taste  and 
smell,  but  is  less  inflammable.  Chloride  of  Methyl  is  generally 
employed  as  a  local  anaesthetic  in  the  form  of  spray,  although  it 
possesses  general  anaesthetic  properties  also,  and  being  very 
volatile  and  ether-like,  rapid  evaporation  occurs  when  it  is 
applied  over  an  effected  area.  To  avoid  producing  inflammation 
of  the  skin,  or  an  erythema  in  persons  having  an  irritable  skin, 
caution  is  necessary ;  and  it  should  be  applied  over  as  many 
nerve  filaments  as  possible.  The  special  advantage  of  chloride 
of  methyl  is  its  external  application,  which  may  never  cause 
more  than  a  temporary  irritation  of  the  skin.  In  order  to 
produce  local  anaesthesia  with  this  agent,  M.  Bardet  proposes 
before  spraying  a  surface  with  it,  to  paint  it  with  glycerine,  the 
revulsive  action  being  less  severe,  and  the  glycerine  forming  a 
surface  on  which  the  drops  of  the  refrigerant  mixture  collect,  and 
which  may  be  readily  removed  after  the  desired  effect  has  been 
produced  ;  the  use  of  glycerine  is  also  said  to  prevent  the  dangers 
of  sloughing.  Dr.  Ch.  Bailly  recommends  the  following  method 
of  applying  this  agent  as  a  local  anaesthetic :  A  tampon  of  dry 
cotton  covered  with  dry  silk  is  sprayed  with  the  anaesthetic  until 
its  temperature  is  reduced  to  23^-55°  C.  below  zero.  The 
tampon  is  then  grasped  with  ebony  pincers  and  applied  for  a  few 
seconds  to  the  parts  to  be  anaesthetized,  and  perfect  abolition 
of  pain  at  once  secured.  Drs.  Daboll  and  Rhein  recommend 
chloride  of  methyl  as  an  application  for  trigeminal  neuralgia, 
giving  immediate  relief  by  paralyzing  the  small  filaments  of  the 
nerve.  The  spray  is  also  used  for  obtunding  sensitive  dentine ; 
it  produces  a  more  intense  cold  than  ether,  and  with  less  pain, 
its  obtunding  effect  lasting  a  longer  time. 


CHLORAL.  329 

CHLORAL. 
CHLORAL    HYDRAS HYDRATE    OF    CHLORAL. 

/or;n«/^.— C2HCI3OH2O. 

Derivation. — Chloral  is  obtained  by  the  action  of  dry  chlorine 
gas  on  absolute  alcohol,  and  is  purified  by  sulphuric  acid  and  a 
small  quantity  of  lime  ;  a  small  quantity  of  water  converts  it  into 
solid  crystalline  hydrate  of  chloral.  It  is  in  the  form  of  a  snow- 
white,  crystalline  mass,  with  a  pungent  odor  and  taste,  soluble  in 
its  own  weight  of  distilled  water,  and  very  soluble  in  alcohol. 
When  heated,  it  fuses  and  evaporates,  leaving  no  residue,  and  in 
the  air  without  combustion. 

Medical  Properties  and  Action. — Hydrate  of  chloral  is  hypnotic 
and  anaesthetic,  possessing  more  of  the  former  and  less  of  the 
latter  property  than  chloroform,  and,  unlike  chloroform,  after  its 
administration  there  is  no  elimination  by  the  breath  or  urine.  It 
diffuses  into  the  blood  rapidly,  causing  an  abundant  flow  of 
saliva,  and  a  cooling  sensation  in  the  stomach,  followed  by 
warmth.  Very  large  quantities  cause  a  high  degree  of  gastric 
irritation,  nausea  and  vomiting ;  very  large  doses  of  chloral 
paralyze  the  heart,  and  produce  a  fall  of  arterial  pressure,  and  a 
slow,  feeble,  or  sometimes  a  rapid  running  pulse.  The  blood 
becomes  dark  and  grumous-looking  with  the  corpuscles  broken 
down.  Taken  in  moderate  quantity  it  stimulates  the  appetite, 
and  produces  muscular  relaxation.  It  is  uniformly  certain  in  its 
action  as  a  hypnotic,  has  no  depressing  influence,  and  does  not 
cause  constipation.  Administered  in  doses  of  gr.  x  to  gr.  xxx,  it 
causes  unconsciousness  to  pain,  and  a  profound  sleep,  lasting 
over  several  hours.  The  sleep  it  produces  is  quiet  and  gentle, 
and  induced  without  distress.  Liebreich  claims  to  have  pro- 
duced sleep  which  lasted  from  five  to  fifteen  hours,  with  from  25 
to  30  grains  of  hydrate  of  chloral. 

The  habitual  use  of  chloral  leads  to  a  disorder  which  is  some- 
what similar  to  the  "  opium  habit,"  although  it  may  not  be  as 
persistent.  When  there  is  present  no  susceptibility  to  its  hyp- 
notic action,  it  is  liable  to  cause  headache,  and  in  some  cases,  a 
delirious  excitement.  Its  hypnotic  action  is  immediately  pre- 
ceded   by   a    stage    of  excitement,  generally  of   short  duration, 


330  DENTAL  MEDICINE. 


which  is  followed  by  sudden  and  complete  sleep,  very  much  like 
natural  sleep,  calm,  dreamless  and  refreshing.  It  differs  from  a 
condition  of  narcotism  from  the  fact  that  the  patient  can  be 
easily  roused  to  partake  of  nourishment,  and  will  readily  fall 
asleep  again. 

There  are  no  unpleasant  after-effects  resulting  from  a  mod- 
erate dose  of  chloral,  differing  in  this  respect  from  morphine, 
which  often  causes  headache,  faintness,  giddiness,  nausea  and 
constipation.  Chloral  is  not  capable  of  producing  insensibility 
to  pain,  unless  the  quantity  administered  is  sufficient  to  suspend 
the  functions  of  the  cerebrum.  Great  care  is  necessary  in  its 
use  where  symptoms  of  pulmonary  disease,  fatty-heart  or 
degenerated  blood  vessels  are  apparent. 

When  a  proper  dose  is  administered  the  pupil  contracts 
slightly,  but  the  pulse  may  remain  unaltered  or  become  slower, 
and  the  respiration  unaffected.  When  an  improper  or  dangerous 
dose  is  taken,  profound  narcotism  ensues,  the  respiration  becomes 
slower,  the  pulse  weak,  rapid  and  irregular,  sensibility  is  lost,  all 
reflex  movements  are  impossible,  and  complete  muscular  relaxa- 
tion follows.  It  destroys  life  by  the  suspension  of  the  functions 
of  the  cerebrum,  and  by  paralysis  of  the  respiratory  centre,  and 
of  the  cardiac  ganglia ;  also  death  may  suddenly  follow  by  paral- 
ysis of  the  heart,  in  cases  of  fatty  degeneration,  and  the  lower 
lobes  of  the  brain  remain  unaffected.  The  paralytic  phenomena 
caused  by  chloral  are  due  to  its  direct  action  on  the  nervous 
centres.  The  congestion  of  the  meninges  of  the  brain  and  cord, 
and  distension  of  the  right  cavities  of  the  heart,  have  been  observed 
after  poisoning  by  chloral.  The  antidote  in  cases  of  poisoning 
is  strychnia,  and  the  same  treatment  as  in  opium  poisoning. 

Therapeutic  Uses. — The  most  important  uses  of  chloral  are  in 
diseases  of  the  nervous  system,  such  as  delirium  tremens,  insan- 
ity, tetanus,  acute  mania,  neuralgia,  chorea,  whooping-cough,  and 
in  rheumatism,  cholera  morbus,  seasickness,  etc.,  etc.  Having 
no  direct  pain-relieving  power,  except  by  suspending  the  func- 
tions of  the  cerebrum  and  in  dangerous  doses,  sleep  can  be  pro- 
cured and  pain  relieved  by  combining  the  chloral  with  morphine, 
when  it  is  very  effective. 


CHLORAL.  331 


Dose. — Of  hydrate  of  chloral,  gr.  v  to  gr.  xx  ;  and  it  must  be 
remembered  that  one-half  drachm  has  produced  poisonous  symp- 
toms. Thirty  grains  of  hydrate  of  chloral  are  equal  in  effect  to 
gr.  j  of  opium.  For  adults,  if  short  intervals  of  sleep  are  re- 
quired, from  gr.  xx  to  xxx  will  answer  j  for  young  children,  gr. 
vij  is  the  dose  recommended.  Moderate  and  frequently  repeated 
doses  are  better  than  a  single  large  one. 

Dental  Uses. — In  dental  practice,  the  hydrate  of  chloral,  in  the 
form  of  gr.  ss  to  gr.  j,  is  applied  to  inflamed  pulps  for  the  relief 
of  odontalgia,  and  is  an  efficient  remedy ;  it  is  also  employed  for 
the  relief  of  neuralgia  of  the  fifth  pair  of  nerves ;  as  a  stimulant 
and  deodorizing  application  to  foul  and  fetid  indolent  ulcers ; 
also  as  a  local  anaesthetic,  for  this  purpose  being  combined  with 
camphor  and  other  agents  (see  Aconite),  (see  Camphor);  also  as 
an  anodyne,  for  the  relief  of  the  pain  of  periodontitis ;  and  as  an 
injection,  for  alveolar  abscesses.  It  is  also  used  as  a  lotion  (when 
diluted  with  water)  for  inflammations  of  the  oral  mucous  mem- 
brane, and  as  an  antiseptic  (chloral,  5j  ;  aqua,  f^ij)  for  injecting 
putrid  pulp-canals  and  chronic  alveolar  abscesses.  Although  it 
is  employed  hypodermically,  yet  painful  phlegmons  have  resulted 
from  its  repeated  application. 

Chloral  Phenol. — When  chloral  is  combined  with  carbolic  acid 
it  liquefies,  and  a  preparation  composed  of  equal  parts  of  phenol 
and  chloral  is  used  for  odontalgia  as  well  as  for  its  antiseptic 
qualities.  Chloral  Phenol  is  a  colorless,  clear  liquid,  soluble  in 
alcohol,  acetic  acid,  amyl-alcohol,  chloroform,  carbon,  glycerin 
and  ether.     It  possesses  the  odor  and  taste  of  its  constituents. 

Chloral  has  the  property,  when  rubbed  with  certain  bodies, 
such  as  camphor,  of  forming  there  with  syrupy  liquids.  With 
phenol  (absolute  carbolic  acid)  it  also  liquefies,  and  a  preparation 
composed  of  equal  parts  of  phenol  and  chloral  is  used  in  dentistry 
for  allaying  toothache,  as  well  as  for  its  antiseptic  properties.  A 
recent  study  by  Fabini,  says  the  Chemist  and  Druggist.,  shows  that 
chloral-phenol  possesses  the  odor  and  taste  of  its  constituents,  and 
when  applied  to  the  skin  produces  inflammation  and  an  eruption 
of  small  blisters.  It  is  a  colorless  and  clear  liquid,  having  a  sp. 
gr,  at  20°  C.  of   1.289,  ^^   ^^^^    '^   sinks   in    anhydrous  glycerin. 


332  DENTAL  MEDICINE. 


It  is  soluble  in  alcohol,  acetic  acid,  amyl-alcohol,  chloroform, 
carbon  bisulphide,  and  glycerin,  as  well  as  in  ether  when  slightly 
warmed.  It  is  only  partially  soluble  in  petroleum  ether,  and 
benzine  only  dissolves  a  little  of  the  fluid,  and  what  is  dissolved 
is  chloral-phenol.  Fabini  tested  the  fluid  thoroughly,  with  a 
view  to  determining  whether  it  is  a  mechanical  mixture,  and  it 
behaved  in  every  way  toward  re-agents  as  carbolic  acid  does, 
while  with  sulphuric  acid  some  of  the  chloral-phenol  yielded,  after 
twenty-four  hours,  a  velvet-colored  plaster-like  mass,  which  con- 
sisted of  meta-chloral  and  phenol-sulphonic  acid.  There  seems 
to  be  no  doubt,  therefore,  that  chloral-phenol  is  a  mixture. 

This  preparation  should  not  be  confounded  with  the  phenol 
camphor  devised  by  Cockrane  (not  campho-phenique),  and  made 
by  mixing  together  i  part  of  carbolic  acid  and  3  parts  of  cam- 
phor. After  twenty-four  hours  this  becomes  a  liquid,  having  a 
sp.  gr.  of  990.  It  is  used  with  oil  as  an  antiseptic.  As  a  spray 
it  may  be  applied  to  the  skin  to  produce  local  anaesthesia.  It 
may  be  employed  for  disinfecting  surgical  instruments,  and  upon 
wool  and  gauze  for  wound  dressing.  It  is  soluble  in  alcohol, 
ether  and  oils,  but  not  in  water  or  glycerin.  Menthol,  cocaine, 
salicylic  acid,  iodoform,  chloral  hydrate,  and  mercuric  chloride  are 
soluble  in  phenol  camphor. 

DENTAL    FORMULAE. 

For  Foul  and  Fetid  Indolent  Ulcers.  For  Foul  and  Fetid  htdolent  Ulcers. 
B .    Chloral  hydratis     .    .   gr.x 

Aquse  destillatse  .    .    .   f^j.        M.  R-    Chloralhydratis  .  .    .355 

SiGNA.— To  be  applied  as  a  lotion.  Adipis gj.         M. 

For  a  Local  Ancesthetic.  SiGNA.— To  be  used  as  an  ointment. 

B .    Chloral  hydratis  .   .    .  5  ij 

Pulveris  camphorae     .  3  ij.        M. 
SiGNA. — To  be  applied  as  an  obtund- 

ing  mixture,  by  means  of  an  appli-  Local  Ancesthetic. 

cator. 

^  ,  Dr.  Storie. 

ror  Odontalgia — Pulpitis. 

Flagg.  B  •    Chloral  hydratis, 

B-    Chloralhydratis.   .    .  !5iij  Camphorre  (gum)  .    .  equal  parts. 

Aqu£e  destill f^ j.        M.  Rub  well  in  a  mortar  to  liquefaction 

SiGNA. — Apply  on  cotton.  and  add  gtt.  v  of  carbolic  acid. 


CHLORALAMID. 


333 


For  a  Hypnotic. 

U.  Chloral hydratis  .  .  ^ij 
Syrupi aurantii  flores  .  "X^'xs 
Syrupi  toluiaui  .  .  .  3  iv 
Aquce  destillatre      .    .  3  vj.       M. 

SiGNA. — Dose  \  part,  largely  diluted. 


For  Neuralgia. 
U .    Chloral  hydratis  .   .    .  partes  3 

Camphora;  ....  partem  I.  M. 
SiGNA. — To   be  applied   over  seat   of 
pain. 

For  a  Local  Amesthetic. 
R .    Chloral  hydratis, 

Pulveris  camphorse     .  aa^ij 

Morphinoe  sulph.     .    .       gss 

Chloriformi    ....       3J.      M. 

SiGNA.  —  Apply     with       camel's-hair 

brush;  dry  rapidly,  and  reapply. 

For  Neuralgia  and  Exposed  Pulps. 
IJ.    Chloral  hydratis  .    .    .  2  parts 
Camphorae        ....  5  parts 
Cocaini  hydrochloratis  i  part.    M. 
Heat  to  about  boiling  point  of  water 
till  liquefied. 
SiGNA. — Apply  locally. 


Local  Antrsthetic. 
U.    Chloral  hydratis  .    .    .  ^j 
Ess.  Menthae   .    .    .    .  ,^js 

Camphorx 3J 

Morphin.  chlor.  hydrat.  gr.ix.      M. 
SiGNA. — Apply  a  small  quantity  upon 
a  pledget  of  cotton. 

Local  Amestketic. 
U,    Chloral  hydratis  .    .    .  gr.xx 
Mur.  cocaine   .        .    .  gr.vj 

Aquae  destill ^vj 

Acidi  Carbolici  .  .  .  TTLij-  M. 
SiGNA. — First  administer  i  drachm  of 
aromatic  spts.  of  ammonia ;  then  in- 
ject a  small  quantity  of  the  mixture 
at  2  or  3  points  under  the  gum,  wait 
5  minutes,  and  then  operate. 

To  Alleviate  the  Pain  of  Tooth 
Extractiott. 
Dr.  Glassington. 
R.    Chloral  hydrate, 

Camphora; aa^ij 

Tinct.  aconite, 

Ciiloroformi    .    .    .     .aa^i.     M. 
SiGNA. — Apply  carefully  with  a  camel's- 
hair  brush  over  root  of  tooth  to  be 
extracted,  and  allow  it   to   remain 
I  or  2  minutes  before  operating. 


CHLORALAiMIDE— CHLORALAMID. 

Formula.— CC\.,-C  H  N  H . 

Derivation. — Formed  by  the  combination  of  two  parts  of 
chloral  hydrate  and  one  part  of  formamide. 

Medical  Properties  and  Action. — Chloralamid  has  been  used  with 
good  results  in  hysteria,  chorea,  acute  mania,  monomania,  typhoid 
fever,  senility,  neurasthenia,  insomnia,  phthisis  and  diseases  not 
attended  by  much  pain.  Mupfenbach,  from  a  number  of  trials, 
regards  it  as  a  useful  hypnotic,  but  with  the  disadvantage  that  its 
certainty  of  action  can  never  be  relied  upon.  No  bad  effects 
upon  the  circulation  or  in  the  feelings  of  the  patient  have  been 
observed  by  Reichmann,  although  vomiting  may  occur.     Accord- 


334  DENTAL  MEDICINE. 

ing  to  Langaard,  this  drug  produced  a  decided  reduction  of  blood- 
pressure,  which  is  developed  more  gradually  and  is  later  in  making 
its  appearance  than  that  caused  by  chloral.  Compared  with 
chloral,  chloralamid  is  more  agreeable  to  the  taste,  and  more 
easily  administered,  rarely  causes  digestive  disorders,  does  not 
depress  the  heart  or  the  circulation,  seldom  produces  cerebral 
disturbances.  Compared  with  sulphonal,  it  is  more  prompt  in  its 
action,  more  soluble,  more  easily  administered,  the  sleep  it  pro- 
duces always  passes  away  by  morning,  and  it  is  less  expensive. 
The  action  of  chloralamid  upon  digestion  is  as  follows : 

1.  Large  quantities  retarded  the  digestion  of  fibrin  in  the 
ratio  of  the  quantity  employed. 

2.  Small  quantities,  for  example,  up  to  0.02  gramme,  did  not 
have  any  marked  influence  either  in  accelerating  or  in  delaying 
the  digestion  of  fibrin. 

3.  Putrefaction  was  not  retarded  by  either  large  or  small 
quantities. 

Therapeutic  Uses. — The  most  important  uses  of  chloralamid 
are  in  diseases  of  the  nervous  system  not  attended  by  much  pain, 
such  as  have  before  been  enumerated. 

Dose. — Of  chloralamid,  gr.  30  to  45.  In  doses  of  twenty  to 
thirty  grains  it  produces  better  effects  than  sulphonal,  but  cau- 
tion in  the  use  of  this  drug  is  necessary  in  diseases  of  the  heart, 
on  account  of  its  causing  decided  reduction  of  blood-pressure. 

DENTAL    FORMULA. 

For  Use  as  a  Hypnotic. 

R.     Chloralamid ziv 

Spts.  vini  gallici ^ij 

Curacao ^  ij.         M, 

SiGNA. — A  tablespoonful  (30  grains  chloralamid)  in  water  and  repeated 
in  4  hours  if  necessary. 

CHLORETONE— TRICHLOR  TERTIARY  BUTYL  ALCOHOL. 
Chloretone  is  a  white  crystalline  compound  with  an  odor  like 
that  of  camphor.  It  is  highly  soluble  in  chloroform,  ether, 
acetone,  alcohol  and  in  glacial  acetic  acid  ;  also  soluble  to  the 
extent  of  one  per  cent,  in  cold  water,  but  more  soluble  in  boil- 
ing   water.     Chloretone,    or    aceton-chloroform,    was    produced 


TRICHLOR  TERTIARY  BUTYL  ALCOLOL.  335 

synthetically  by  Willgerodt  in  1881,  and  unaware  of  these  ex- 
periments, John  J.  Abel  in  1891  discovered  its  value  as  a  prac- 
tical hypnotic  and  anaesthetic. 

Medical  Properties  and  Therapeutic  Action. — Experiments  with 
moderate  doses  of  chloretone  on  animals  caused  a  profound  sleep 
and  complete  anaesthesia  which  lasted  for  several  hours ;  and 
very  large  doses  induced  anaesthesia  which  continued  for  four 
days,  without  ill  effects  on  recovery.  It  has  no  action  on  the 
blood,  and  no  toxic  effect  on  the  heart,  and  is  supposed  to  be 
decomposed  in  the  body,  as  the  largest  doses  failed  to  show  anv 
signs  in  the  urine,  and  its  use  increased  the  chlorides  in  the  urine. 

It  is  a  hypnotic  and  nervous  sedative,  its  action  resembling  that 
of  chloral,  but  not  depressing  the  heart  or  respiration,  unless 
excessive  quantities  are  given  ;  it  also  acts  as  a  sedative  to  the 
stomach  without  irritating  it.  It  is  efficient  in  vomiting  due  to 
irritation,  and  relieves  the  pain  of  gastric  carcinoma.  Donald 
reports  a  case  in  which  120  grains  of  chloretone  were  taken  in 
the  course  of  24  hours,  which  caused  a  profound  sleep  lasting  for 
six  days,  without  any  bad  effects  except  gastric  irritability. 

The  one  per  cent,  solution  has  marked  germicidal  properties, 
and  is  used  as  a  local  anaesthetic  to  irritable  ulcers,  and  infected 
wounds.  It  is  also  effective  as  a  local  anaesthetic  in  minor  sur- 
gical operations. 

Dose. — Of  chloretone,  gr.  ij  to  x  although  gr.  viij  to  xx  have 
been  given  in  12  hours,  in  the  form  of  sugar-coated  tablets  of  3 
grains  each. 

Dental  Uses.- — For  a  local  anaesthetic  in  the  extraction  of 
teeth  ;  as  an  obtundent  for  hypersensitive  dentine ;  for  the  re- 
moval of  living  pulps  of  teeth ;  for  relief  of  pain  in  setting 
crowns  and  bridge-work ;  the  ethereal  solution  being  employed 
in  removing  pulps.  It  appears  to  possess  all  the  good  qualities 
of  cocaine  and  betaeucaine,  without  any  of  the  objectionable 
effects  of  either.  Dr.  M.  Leo  recommends  a  solution  for  extract- 
ing teeth,  prepared  bv  mixing  15  per  cent,  of  alcohol  with  85 
per  cent,  of  distilled  water  and  adding  enough  chloretone  to  make 
a  saturated  solution  :  also  a  solution  made  by  mixing  equal  parts 
by  weight  of  ether  and   chloretone,  for  use   as  an  obtundent  in 


336  DENTAL  MEDICINE. 


preparing   painful   cavities   for  fillings,  and   setting   crowns,  and 
bridge- work. 

Dr.  A.  I.  Welsh  recommends  the  following  solution,  which 
he  claims  to  have  used  on  hypersensitive  dentine  with  marked 
success,  and  which,  in  preparing  cavities  in  teeth,  caused  but 
little  pain  :  ^i.  Chloretone  oj4,  sulphuric  ether  5ij)  aquae  distill, 
q.s.  to  make  i  ounce.  After  standing,  this  solution  being  non- 
miscible,  divided  into  a  solution  of  chloretone  and  ether,  and  a 
solution  of  chloretone  and  water.  The  floating  ethereal  solution 
was  used  with  success  on  sensitive  dentine ;  the  aqueous  solution 
under  the  ether  layer  was  injected  into  the  gums  for  the  extrac- 
tion of  teeth,  and  in  one  case  nine  teeth  were  extracted  with 
little  pain,  and  with  less  risk  than  when  cocaine  is  used.  Dr. 
C.  E.  Klopp  suggests  a  solution  of  j4  drachm  of  oil  of  gaul- 
thesia,  ^  drachm  of  pure  alcohol,  to  which  i8  grains  of  chlore- 
tone are  added  ;  after  the  chloretone  is  dissolved,  the  mixture  is 
added  to  I  ounce  of  distilled  water  and  then  filtered  to  obtain 
a  clear  solution,  and  claims  great  success  with  it  in  the  extraction 
of  teeth.  Some  recommend  waiting  six  or  seven  minutes  after 
injecting  before  operating. 

CHLORINIUM— CHLORINE. 

Symbol. — CI. 

Derivation. — Chlorine  is  a  greenish-colored  gas,  of  a  penetra- 
ting and  suffocating  odor,  very  persistent  and  characteristic.  It  is 
soluble  in  water,  in  the  proportion  of  two  volumes  of  the  gas  to 
one  of  water,  and  is  a  supporter  of  combustion.  It  is  generated 
from  black  oxide  of  manganese,  hydrochloric  acid  and  water,  is 
an  active  irritant,  and,  when  breathed,  excites  cough,  a  sense  of 
suffocation  and  irritation  of  the  mucous  membrane  of  the  nos- 
trils and  bronchial  tubes,  and,  when  considerable  quantities  are 
inhaled,  it  induces  spitting  of  blood,  violent  pains,  and  sometimes 
death.  It  is  a  deodorizer  and  disinfectant,  and  has  been  used  to 
destrov  disease  germs  and  offensive  effluvia. 

Chlorine  Water. — Jqua  Chlori — Formula. — HjOiCl — is  an 
aqueous  solution  of  chlorine,  formed  bv  passing  the  gas  through 
water.     It  is  a  greenish-yellow  liquid,  with   an  astringent  taste 


CHLOROFORM.  337 


and  the  suffocating  odor  of  chlorine  gas.  It  should  be  kept  in 
glass-stoppered  bottles,  in  a  cool  place,  and  protected  from  the 
light. 

Therapeutic  Uses. — Chlorine  water  is  used  internally  in  ma- 
lignant fevers,  such  as  scarlet  fever,  typhus,  and  in  diphtheria, 
aphthas,  gangrene,  syphilis,  diseases  of  the  liver,  skin  diseases, 
etc. ;  and  as  an  antidote  for  hydrocyanic  acid.  The  poisonous 
effects  of  chlorine  gas  may  be  prevented  by  ammoniacal  gas. 
Albumen  is  the  antidote  for  chlorine  water,  given  freely,  in  the 
form  of  milk,  flour,  eggs,  etc. 

Dose. — Of  chlorine  water,  foj  to  f5iv,  diluted. 

Dental  Uses. — Chlorine  water  is  employed  in  dental  practice 
as  a  local  application  in  gangrene  of  the  mouth  and  fauces, 
aphthae,  cancrum  oris,  and  fetor  of  the  breath.  Chlorine  gas 
has  been  employed  to  bleach  discolored  teeth,  care  being  taken 
that  it  reaches  no  other  part  than  the  cavity  of  the  tooth  under- 
going such  treatment,  which  may  be  accomplished  by  the  appli- 
cation of  a  large  rubber  dam,  such  as  is  used  in  the  operation  of 
filling  teeth. 

DENTAL    FORMULAE. 

For    Aphtha:    and    Gangrene    of  the       For  Aphthce,  Stomatitis,  and  Cancrum 

Mouth.  Oris. 

■R.    Aqurechlori ^ss  ^      Liquoris  chlori 

Aquse  destillatae    .    .    .  ^iiiss  Mellis aagij.  M. 

Syrupi  simp ^  ss.     M. 

SiGNA.-To    be    used    as  a  gargle  or  Signa.-To  be  applied  as  a  lotion, 
lotion. 

For  Mercurial  Stomatitis. 
For  Fetor  of  the  Breath  and  an  Anti- 
septic. R  •    Liquoris  chlori    .    .  part  j 
R.    Liquoris  chlori    .    .    .    .  ^iv  Aqua  destillatse  .    .  parts  viij.   M. 

Mellis ^^iv  SiGNA. — To  be  used  as  a  gargle  for 

Aqu£e  destillatae      .    .    .  3  x.     M.  correcting  the  fetor,  and  diminishing 

SiGXA. — To  be  applied  as  a  gargle.  slightly  the  discharge. 

CHLOROFORMUM— CHLOROFORM. 
Formula. — CHCI3.      Sp.  gr.  1. 491. 

Derivation. — Chloroform    is    obtained    bv   the    distillation   of 
alcohol  with   chlorinated   lime,  or  by  the  action  of  chlorine  upon 
alcohol.      It  is  a  colorless,  limpid,  neutral,  and  volatile  fluid,  with 
22 


338  DENTAL  MEDICINE. 

a  hot,  aromatic,  sweetish  taste,  and  a  peculiar  fragrant  odor.  It 
is  readily  soluble  in  alcohol  and  in  ether,  and,  if  pure,  it  sinks  into 
water  as  transparent  globules  free  of  milkiness.  It  is  antiseptic, 
and  will  not  coagulate  albumen.  It  should  be  kept  in  a  dark, 
cool  place.  If  exposed  to  the  light  for  any  length  of  time, 
chloroform  becomes  unfit  for  use  as  it  develops  chlorine,  hy- 
drochloric acid,  and  carbonyle  chloride.  The  presence  of  acid 
in  chloroform  will  turn  blue  litmus  paper  red,  and  if  chlorine  is 
present  it  will  form  a  white  precipitate  with  nitrate  of  silver.  If 
impure  from  improper  manufacture,  an  oily  odor  will  remain  on 
the  hand  after  evaporation.  Chloroform  fit  for  use  {Chlorofor- 
mum  Purificatuni)  should  have  a  specific  gravity  of  from  1.49 1  to 
1,525,  absolutely  transparent  and  colorless,  neutral  to  test  paper, 
non-irritating  when  inhaled,  and  should  evaporate  entirely,  leav- 
ing no  residue  or  smell  on  a  glass  surface.  Chloroform  purified 
by  crystallization  is  considered  to  be  the  best  form  for  purity. 
The  boiling  point  is  142°  F. 

Medical  Properties  and  Physiological  Action. — Chloroform,  when 
inhaled,  is  an  anaesthetic;  and  when  administered  internally,  is 
anodyne  and  antispasmodic.  Its  effects  on  the  system  are  similar 
to  those  of  ether,  but  more  powerful  and  more  rapidly  produced, 
and  it  requires  more  care  in  its  administration,  both  internally 
and  by  inhalation  of  the  vapor.  When  inhaled,  the  vapor  of 
chloroform  causes  a  sensation  of  warmth  in  the  mouth  and 
throat,  a  sense  of  relaxation,  and  finally  unconsciousness. 
Respiration  is  at  first  full  and  deep,  but  soon  becomes  more 
rapid  and  shallow.  The  pulse  becomes  at  first  somewhat  fuller 
and  stronger  for  a  short  time,  and  then  fails  in  strength,  and  is 
more  rapid.  Total  muscular  relaxation  is  dangerous.  The 
effect  on  the  air  passages  is  slight  irritation,  with  no  primary  ar- 
rest of  the  respiration,  as  is  the  case  with  ether.  The  pupils  at 
first  slightly  dilate,  but  afterwards  contract :  but  if  they  dilate 
after  such  contraction  the  case  becomes  dangerous,  and  death 
may  suddenly  ensue.  In  some  patients,  the  first  effects  of  the  chlo- 
roform are  violent  struggles,  and,  in  such  cases,  it  is  dangerous 
to  continue  the  inhalation  rapidlv.  Drunkards  and  athletes  are 
prone  to  be   thus   affected.     When  taken  internally  it  causes  a 


CHLOROFORM.  339 


feeling  of  warmth  in  the  stomach,  followed  by  coldness,  similar 
to  ether,  and  if  taken  in  large  quantity,  undiluted,  it  acts  as  an 
irritant  poison,  inducing  violent  gastritis.  It  is  diffused  into  the 
blood,  and  affects  remote  parts.  It  increases  the  action  of  the 
circulatory  system,  producing  excitement  of  the  brain,  followed 
by  a  deep,  heavy  sleep;  and  in  poisonous  doses,  stupor  and  in- 
sensibility. 

The  first  effect  of  chloroform  is  upon  the  brain,  then  upon 
the  sensory  portion  of  the  spinal  cord,  then  the  motor  part  of 
the  cord,  then  the  sensory  parts  of  the  medulla  oblongata,  then 
its  motor  portion,  thereby  causing  death  through  the  failure  of 
the  vaso-motor  and  respiratory  centres,  unless  heart  failure  has 
already  taken  place,  which  is  not  usually  the  case. 

When  locally  applied,  chloroform  acts  as  an  irritant  and  anaes- 
thetic on  the  sensory  and  motor  nerves,  but  when  inhaled  has 
little  or  no  effect  on  these  nerve  trunks.  Recent  investigations 
have  shown  that  "  the  primary  action  of  chloroform  on  the  vital 
functions  of  circulation  and  respiration  is  greatly  to  depress  the 
vaso-motor  system,  thereby  causing  an  extraordinary  fall  of 
blood-pressure.  Some  cardiac  enfeeblement  and  dilatation  adds 
to  the  fall  of  pressure."  Chloroform  has  little  or  no  effect  upon 
the  blood  when  it  is  inhaled,  but  lowers  the  bodily  temperature 
by  assisting  in  the  dissipation  of  heat,  and  its  action  on  the  nerv- 
ous production  of  heat.  Owing  to  its  great  volatility,  chloro- 
form is  rapidly  eliminated  by  the  kidneys  and  lungs. 

Locally  applied  to  the  skin,  it  causes  redness  and  burning  and 
if  confined  so  that  evaporation  is  prevented,  will  induce  vessica- 
tion.  It  is  somewhat  anaesthetic  when  locally  applied,  but  is 
also  a  powerful  irritant.  The  vapor  of  chloroform  when  inhaled 
produces  symptoms  similar  to  those  of  ether,  except  that  the 
sensations  of  choking  are  absent,  and  the  stage  of  excitement  is 
of  shorter  duration  and  less  violent. 

Sabarth  has  divided  chloroform-narcosis  into  three  stages  :  In 
the  first,  the  symptoms  are  similar  to  alcoholic  intoxication. 
The  second  stage  is  that  of  anaesthesia,  consciousness  and  sensi- 
bility are  abolished,  the  muscles  are  relaxed,  and  perfect  quiet 
ensues.     This  is  the  surgical  stage. 


340  DENTAL  MEDICINE. 


The  third  stage  is  one  of  profound  narcosis,  with  stertorous 
breathing,  intense  muscular  relaxation,  abolition  of  the  ordinary 
reflexes,  and  fall  of  bodily  temperature.  This  is  a  dangerous 
stage,  and  its  induction  is  not  justifiable,  except  under  very  pecul- 
iar circumstances. 

The  following  are  some  of  the  practical  conclusions  of  the 
second  Hyderabad  Commission  :  "  The  recumbent  position  on 
the  back  and  absolute  freedom  of  respiration  are  essential.  If 
during  an  operation  this  position  cannot  be  from  any  cause  main- 
tained during  the  administration  of  chloroform,  the  utmost  atten- 
tion to  the  respiration  is  necessary  to  prevent  asphyxia  or  an 
over-dose.  If  there  is  any  doubt  about  the  state  of  respiration, 
the  patient  should  be  at  once  restored  to  the  recumbent  position 
on  the  back.  To  insure  absolute  freedom  of  respiration,  tight 
clothing  of  every  kind,  either  on  the  neck,  chest,  or  abdomen,  is 
to  be  strictly  avoided;  and  no  assistants  or  bystanders  should  be 
allowed  to  exert  pressure  on  any  part  of  the  patient's  thorax  or 
abdomen,  even  though  the  patient  be  struggling  violently.  If 
struggling  does  occur,  it  is  always  possible  to  hold  the  patient 
down  by  the  shoulders,  pelvis,  or  legs,  without  doing  anything 
that  can  possibly  interfere  with  the  free  movements  of  respira- 
tion. An  apparatus  is  not  essential,  and  should  not  be  used,  as, 
being  made  to  fit  the  face,  it  must  tend  to  produce  a  certain 
amount  of  asphyxia,  and  take  up  part  of  the  attention  required 
elsewhere.  However  it  is  made,  it  introduces  an  element  of 
danger  into  the  administration.  A  convenient  form  of  inhaler  is 
an  open  cone  or  cap  with  a  little  absorbent  cotton  inside  at  the 
apex.  At  the  commencement  of  inhalation  care  should  be  taken 
by  not  holding  the  cap  very  close  over  the  mouth  and  nose,  to 
avoid  exciting,  struggling  or  holding  the  breath.  If  struggling  or 
holding  the  breath  does  occur,  great  care  is  necessary  to  avoid  an 
over-dose  during  the  deep  inspirations  which  follow.  When 
quiet  breathing  ensues,  as  the  patient  begins  to  go  over,  there  is 
no  reason  why  the  inhaler  should  not  be  applied  close  to  the  face ; 
and  all  that  is  then  necessary  is  to  watch  the  cornea  and  see  that 
the  respiration  is  not  interfered  with. 

In   children,  the    free  admission  of  chloroform  into  the  lungs 


CHLOROFORM.  • 341 


causes  nervous  excitement ;  but  the  struggling  and  holding  the 
breath  can  hardly  be  avoided,  and  one  or  two  whifFs  of  chloro- 
form may  be  sufficient  to  produce  complete  insensibility.  They 
should  always  be  allowed  to  inhale  a  little  fresh  air  during  the 
first  deep  inspirations  which  follow. 

In  struggling  persons,  but  especially  in  children,  it  is  essential 
to  remove  the  inhaler  after  the  first  or  second  deep  inspiration,  as 
enough  chloroform  may  have  been  inhaled  to  produce  deep 
anaesthesia,  and  this  may  only  appear,  or  may  deepen,  after  the 
chloroform  is  stopped.  Struggling  is  best  avoided  in  adults  by 
making  them  blow  out  hard  after  each  inspiration  during  the  in- 
halation. The  patient  is,  as  a  rule,  anaesthetized  and  ready  for 
the  operation  to  be  commenced  when  unconscious  winking  is  no 
longer  produced  by  touching  the  surface  of  the  eye  with  the  tip 
of  the  finger. 

The  anaesthesia  should  never,  under  any  circumstances,  be 
pushed  until  respiration  stops ;  but  when  once  the  cornea  is  in- 
sensitive, the  patient  should  be  kept  gently  under  by  occasional 
inhalations,  and  not  be  allowed  to  come  out  and  renew  the  stage 
of  struggling  and  resistance. 

As  a  rule  no  operation  should  be  commenced  till  the  patient  is 
fully  under  the  influence  of  the  anaesthetic,  so  as  to  avoid  all 
chances  of  death  from  surgical  shock  or  fright.  The  administra- 
tor should  be  guided  as  to  the  effect  entirely  by  the  respiration  ; 
and  his  only  object,  while  producing  anaesthesia,  is  to  see  that  the 
respiration  is  not  interfered  with.  If  possible  the  patient's  chest 
and  abdomen  should  be  exposed  during  chloroform  inhalation,  so 
that  the  respiratory  movements  can  be  seen  by  the  administrator. 
If  anything  interferes  with  the  respiration  in  any  way,  however 
slightly,  even  if  this  occurs  at  the  commencement  of  the  admin- 
istration, if  breath  is  held  or  if  there  is  stertor,  the  inhalation 
should  be  stopped  till  the  breathing  is  natural  again.  This  may 
sometimes  create  delay  and  inconvenience,  but  experience  will 
make  any  administrator  so  familiar  with  the  respiratory  functions 
under  chloroform,  that  he  will  in  a  short  time  know  almost  by 
intuition  whether  anything  is  going  wrong,  and  be  able  to  put  it 
right  without  delay,  before  any  danger  arises.     If  the  breathing 


34:2  •  DENTAL  MEDICINE. 


becomes  embarrassed,  the  lower  jaw  should  be  pulled  or  pushed 
from  behind  the  angles,  forward,  so  that  the  lower  teeth  protrude 
in  front  of  the  upper.  This  raises  the  epiglottis  and  frees  the 
larynx.  At  the  same  time  it  is  well  to  assist  the  respiration  arti- 
ficially till  the  embarrassment  passes  off.  If,  by  any  accident  the 
respiration  stops,  artificial  respiration  should  be  commenced  at 
once,  while  an  assistant  lowers  the  head  and  draws  forward  the 
tongue  with  catch  forceps,  by  Howard's  method,  assisted  by 
compression  and  relaxation  of  the  thoracic  walls.  Artificial 
respiration  should  be  continued  till  there  is  no  doubt  whatever 
that  natural  respiration  is  completely  reestablished.  A  small  dose 
of  morphia  may  be  injected  subcutaneously  before  chloroform  in- 
halation, as  it  helps  to  keep  the  patient  in  a  state  of  anaesthesia  in 
prolonged  operation.  There  is  nothing  to  show  that  atropine 
does  any  good  in  connection  with  the  administration  of  chloro- 
form, and  it  may  do  much  harm.  Alcohol  may  be  given  with 
much  advantage  before  operations  under  chloroform,  provided  it 
does  not  cause  excitement,  and  merely  has  the  effect  of  giving  a 
patient  confidence  and  steadying  the  circulation.  And  it  is  the 
opinion  of  the  Commission  that  "  if  the  above  rules  be  followed, 
chloroform  may  be  given  in  any  case  requiring  an  operation, 
with  perfect  ease  and  absolute  safety,  so  as  to  do  good  without 
the  risk  of  evil." 

In  operations  on  the  mouth  the  chloroform  vapor  may  be  ad- 
ministered by  passing  a  soft  catheter  into  the  nose  and  by  means 
of  a  hand-bulb,  or  Junker  inhaler  and  thus  force  the  vapor  into 
the  post-nasal  spaces. 

[For  the  Administration  of  Anaesthetics,  Dangers  of  Anaes- 
thesia, Preventive  Measures,  and  Treatment  of  Dangerous 
Symptoms,  the  reader  is  referred  to  the  article  on  Sulphuric 
Ether.] 

Therapeutic  Uses. — Besides  its  use  as  a  general  anaesthetic  agent, 
chloroform  is  internally  administered  in  substance,  as  an  anodyne 
and  antispasmodic,  for  non-inflammatory  affections,  such  as 
nausea  and  vomiting,  seasickness,  sick  headache,  flatulent  colic, 
intermittent  fevers,  and  in  cholera,  for  which  it  is  very  efiicicnt. 
The  vapor  is  employed    for  the  relief  of  hay  asthma,  whooping- 


CHLOROFORM.  343 


cough,  spasmodic  asthma,  and  as  a  hypnotic  in  delirium  tremens, 
and  as  an  injection  and  lotion  in  neuralgia,  and  as  a  counter- 
irritant  or  vesicant,  for  which  purposes  it  is  applied  to  the  skin, 
and  evaporation  prevented.  Great  care  is  necessary  in  the  ad- 
ministration of  chloroform  in  substance,  as  fatal  effects  have 
followed  such  use;  15  drops  have  destroyed  life.  Externally, 
chloroform  is  employed  as  a  stimulating  application  to  foul  and 
indolent  ulcers. 

Anesthetic  Mixtures. — The  A.  C.  E.  mixture  consists  of  i 
part  of  alcohol  (sp.  gr.  .838),  2  parts  of  chloroform  (sp.  gr.  1.497), 
and  3  parts  of  ether  (sp.  gr.  .735). 

The  object  of  this  mixture  is  to  produce  the  anaesthetic 
effect  of  the  ether  and  chloroform  without  the  cardiac  and 
respiratory  effects  of  either,  the  alcohol  being  added  to  act  as  a 
stimulant. 

Schleich's  mixtures  are  composed  of  chloroform,  ether  and  pe- 
troleum ether,  the  latter  boiling  at  60°  to  65°  C,  The  petro- 
leum ether  has  no  injurious  effect,  and  appears  to  modify  the  effect 
of  the  chloroform  and  dilute  the  ether  without  changing  the  gen- 
eral influence  of  either.  Such  mixtures  are  said  to  cause  less 
mucous  secretion,  less  cyanosis  and  other  disagreeable  effects  than 
any  single  anaesthetic. 

Dr.  Spark  recommends  highly,  as  a  hemostatic  agent,  a  solu- 
tion composed  of  chloroform  2  parts,  water  200  parts.  He  claims 
that  it  acts  with  a  rapidity  that  is  truly  marvelous,  and  it  has  not 
the  slightest  disagreeable  taste.  It  is  useful  in  all  operations  upon 
the  mouth  and  throat.  Dr.  A.  Guerin,  of  Paris,  claims  that 
death  from  chloroform  may  be  avoided  if  inhaled  exclusively 
through  the  mouth,  holding  the  nose.  When  death  occurs  from 
stoppage  of  the  heart,  the  cardiac  muscular  fibres  cease  to  con- 
tract under  the  influence  of  a  reflex  action  exerted  by  the  nasal 
nerves  on  the  pneumo-gastric,  stimulating  the  inhibitory  power  of 
the  latter  on  the  heart.  When  a  rabbit  is  made  to  inhale  chloro- 
form directly  through  an  opening  in  the  trachea,  the  drug  has  no 
effect  whatever  on  the  heart.  On  the  contrary,  when  the  chlo- 
roform is  held  before  the  nose  of  the  rabbit,  the  heart  immediately 
stops. 


344  DENTAL  MEDICINE. 


j)o5e. — Of  chloroform,  Tltj  to  v,  in  sweetened  water  or  muci- 
lage.    Dose  of  chloroform  for  inhalation,  oj  to  5ij- 

Spirit  of  Chloroform — Spiritus  Chloroforini — is  composed  of  chlo- 
roform, 5j ;  diluted  alcohol,  S'j-  Dose  of  spirit  of  chloroform, 
5ss  to  5j- 

Morphia  and  Chloroform  Narcosis. — A  method  practiced  by 
Prof.  Thiersch,  of  Leipsic,  succeeds  often  in  inducing  a  perfect, 
analgesia  without  unconsciousness.  Morphine  is  first  hypoder- 
mically  injected,  and  in  from  five  to  seven  minutes  afterwards  the 
patient  is  very  lightly  chloroformed  till  near  the  stage  of  excite- 
ment ;  the  operation  is  performed ;  as  soon  as  pain  is  felt,  if  the 
operation  is  a  prolonged  one,  a  little  chloroform  is  added.  In  this 
manner  not  the  tenth  part  of  chloroform  is  needed,  and  it  is 
claimed  that  the  operation  is  as  painless  as  under  full  chloroform 
narcosis,  and  there  is  no  risk  of  danger  incurred.  Men  receive 
one-half  a  grain  of  morphine,  women  one-quarter  of  a  grain,  chil- 
dren one-twelfth  to  one-eighth  of  a  grain. 

Cocaine-Chloroform  Narcosis. — This  consists  essentially  in  the 
combined  use  of  cocaine  and  chloroform,  and  is  strongly  favored 
by  Prof.  Obolinski,  of  Cracow,  who  injects  either  before  or  after 
the  anaesthesia  is  obtained,  from  one  to  three  centigrammes  of 
cocaine;  or  he  injects  in  the  neighborhood  of  the  seat  of  the  op- 
eration, and  during  its  progress,  from  three  to  seven  centigrammes. 
Cocaine  is  used  on  the  ground  that  it  is  a  complete  antagonist  of 
chloroform  and  chloral ;  but  it  is  not  so  regarded  by  others,  who 
represent  it  to  be  a  general  excitor  of  the  central  nervous  gray 
matter,  rather  than  a  direct  and  powerful  stimulator  of  the  heart, 
while  its  stimulant  effect  upon  respiration  is  not  to  be  depended 
upon.  Prof.  Obolinski  claims  that  this  mixed  narcosis  secures 
anaesthesia  with  the  use  of  less  chloroform,  and  that  vomiting  is 
prevented,  and  there  are  fewer  disagreeable  after-effects. 

Dental  Uses. — Chloroform  is  employed  in  dental  practice  as  a 
general  anaesthetic,  also  as  a  local  anaesthetic,  for  which  purpose  it 
is  generally  combined  with  other  agents ;  as  an  anodyne  and  an- 
tispasmodic, either  locally  applied  or  the  vapor  inhaled,  as  in  the 
treatment  of  convulsions  of  dentition,  for  which  it  is  a  very  effi- 
cient remedy. 


CHLOROFORM. 


345 


DENTAL 

For  Neuralgic  Affections. 
U .     Chloroformi, 

Spirit!  ammonia, 

Tincturae  aconiti    .    .  aii  f^j 

Olei  ricini ^ij 

Linimenti  saponis  .    .      f  J  j.    M. 
SiGNA. — To  be  applied  as  a  liniment 
over  seat  of  pain. 

For  a  Local  Ancesthetic. 
R .     Chloroformi  purificati, 
Tincturae  aconiti, 
Alcoholis  ...  aa  f^j 

Morphinae  sulphat.  .    .  gr.vj.     M. 
SiGNA. — Apply  for  I  or  2  minutes  to 
gum  over   root  of  tooth  to    be   ex- 
tracted. 

For  a  Local  Anccsthelic. 
Von  Bonhorst. 
IJ .     Chloroformi, 
.(^theris  sulph., 
Spiriti  lavandulae, 
Pyrethri  (fluid  ext.)  .  aa  f,^j.    M. 
SiGNA. — Apply  for  i  or  2  minutes  to 
gum  over   root  of  tooth  to   be  ex- 
tracted. 

For  Odontalgia — Pulpitis. 

R.     Choroformi Jij 

Alcoholis ^j 

/Ether ^ss 

Camphorae  (pulv.)  .    .  ^  ss 

Tinct.  opii ^^ss 

Oleum  caryophylli  .    .  §j.        M. 

SiGNA. — Apply  on  cotton  wool,  to  ex- 
posed pulp. 

For  iVeuralgic  Affections  of  the   Teeth. 
R  .     Chloroformi    ....  f  ^^  j  or  ij 

Aqute Oj.  M. 

SiGNA. — To  be  used  as  a  wash  or  a 
gargle. 


For  A'euralgic  Affections. 
R,     Chloroformi       .    .    .    .  ^ij 

Camphorae ^'ss 

Olei  olivae g  ij.      M. 

SiGNA. — To  be  applied  as  a  liniment 
over  seat  of  pain. 

For  Odontalgia — Pulpitis. 

U.     Chloroformi, 

Tinct.  aconiti  .    .    .  iia  f 3  iij 
Tinct.  capsici  ...        f^j 
Tinct.  pyrethri, 
Olei  caryoph.  .    .    .  aa  f  5  ss 
Camphorae  (pulv.)  .         ^  ss.     M. 

SiGNA. — Apply  on  cotton  wool. 

For  an  Anodyne  Application  in  A^eu- 
ralgia. 

R.     Chloroformi      ....  fzj 

Linimenti  camphorae  .  f ^  ij.     M. 
SiGNA. — To   be   applied   over  seat  of 

pain,  and  covered  with  oiled  silk,  to 

prevent  evaporation. 

For  Earache  of  Dentition. 
R.     Chloroformi ^j 

Olei  olivae ^j 

SiGNA. — Pour  from  gtt.  x  to  xx  in  ear, 
and  close  orifice  with  cotton. 

For  a  Local  Ancesthetic. 

R.     Chloroformi part  xx 

Acidi  acetici  (cryst.)    .  part  j.  M. 
SiGNA. — Apply  with  camel's-hair  brush, 
or  by  applicator. 

For  Excessive  Vomiting  and  Irritability 
during  Infantile  Diarrhxa. 
Dr.  Jas.  W,  White. 
R.     Spt.  Chloroformi  .    .    .   ^j 

Creasote tl^ij 

Vin.  ipecac ttl^v 

Aquae  anisi  .    .  q.s.  ad.    ^ij.     M. 
Signa. — A  teaspoonful  in  a  little  water 
for  a  child  I  year  old. 


346 


DENTAL  MEDICINE. 


Local  Anasthetic. 

Dr.  Parsc 

)N. 

R .     Chloroformi  .    . 

.    .12  parts 

Tinct.  aconiti 

.    .12  parts 

Tinct.  capsici 

.    .    4  parts 

Tinct.  pyrethii  . 

.    .     2  parts 

Olei  caryophilli 

.    .    2  parts 

Camphorse     .    . 

.    .     2  parts 

Dissolve  the  campho 

r  in  the  chloro- 

form,  then  add  the  oil 

of  cloves,  then 

the  tinctures. 

For  Pain  after  Extraction. 

Dr.  T.  F.  Chupein. 

JJ .     Chloroformi 

Tinct.  aconiti  .    .    .  aa  f  3  j 


R.     Tinct.  camphora  .    .    -  3J 

Chloroformi ^  'J 

or 
R .     Morphinae     ...        .  grs.iij 

Tinct.  aconiti, 

Chloroformi, 

Alcohol aafjss 

For  Pain  after  Extraction. 
Dr.  D.  Genese, 

R .     Chloroformi I  part 

Tinct.  pyrethri  ....  3  parts 

Local  Anccsthetic. 
Dr.  Frank  Abbott. 
R .     Chloroformi, 

Tinct.  aconiti  rad.    .    iia  ^j 

Alcoholis ^j 

Morphinse  sulph.       .    .  grs.xii. 
SiGNA. — Used  locally. 


CINCHONA  FLA V A— YELLOW  CINCHONA. 
CALISAYA    BARK PERUVIAN    BARK. 

Source. — Cinchona  is  the  bark  of  the  tree  cinchona  calisaya, 
which  grows  on  the  western  coast  of  South  America,  especially 
of  Bolivia  and  Southern  Peru.  Different  varieties  are  named, 
according  to  their  color,  as  Cinchona  Flava.,  yellow  cinchona  ;  C/>/- 
chona  Pallida.^Y*di\c  c'mchom.;  Cinchona  Rubra^  red  c'lnchom.  The 
medical  properties  of  these  barks  depend  upon  the  alkaloids  they 
contain  in  varying  proportions,  ^uinina  being  the  most  important. 

Medical  Properties  and  Action. — The  yellow  bark  has  a  much 
more  bitter  taste  than  the  others,  but  is  comparatively  free  from 
acidity.  It  is  brownish  yellow,  the  powder  being  of  an  orange 
color,  and  it  containsmore  of  the  alkaloid  quinine  than  the  other 
barks. 

Cinchona  is  tonic,  astringent  and  antiperiodic,  and  the  dif- 
ferent varieties  owe  their  tonic  and  antiperiodic  properties  to  the 
alkaloids  quinina.,  cinchonina  and  cinchonidina.  On  account  of 
the  large  quantity  of  the  powdered  barks  it  is  necessary  to  take 
in  order  to  obtain  the  full  effects,  and  which  cause,  in  some 
cases,  derangement  of  the  stomach,  vomiting,  headache  and  con- 


YELLOW   CINCHONA,  347 


stipation,  the  alkaloid  quinine,  in  the  form  of  sulphate  of  quinina, 
is  preferable. 

Sulphate  of  Quinina — ^inincs  Sulphas — is  prepared  by 
boiling  the  yellow  bark  in  water  acidulated  with  hydrochloric 
acid,  by  which  the  alkaloid  is  separated  from  its  combination 
with  kinic  and  other  acids,  to  form  a  soluble  hydrochlorate. 
This  salt  is  decomposed,  and  the  quinine  is  precipitated  by  the 
addition  of  lime,  and  afterwards  washed  in  boiling  alcohol. 

Sulphate  of  quinine  is  in  the  form  of  colorless,  very  light  and 
silky  crystals,  and  is  readily  soluble  in  alcohol,  and  in  water 
acidulated  with  sulphuric  acid.  It  is  insoluble  in  ether,  and  requires 
740  parts  of  cold,  or  30  parts  of  boiling  water  to  entirely  dissolve  it. 

Cinchona  is  also  antiseptic,  as  the  powder  dusted  over  un- 
healthy wounds  will  arrest  putrefaction,  and  promote  healthy 
cicatrization.  Quinina  will  destroy  minute  organisms,  and 
preserve  substances  from  decomposition.  The  cinchona  alka- 
loids are  readily  diffused  into  the  blood,  and  when  hypodermic- 
ally  injected,  are  absorbed  by  the  blood.  Cinchona  and  its 
alkaloids  increase  the  action  of  the  heart  slightly,  but  in  large 
doses  quinine  depresses  the  heart's  action  and  enfeebles  the  pulse. 
As  quinine  accumulates  in  the  brain,  a  sense  of  fulness  in  the 
head,  a  tightness  and  constriction  about  the  forehead,  a  ringing 
in  the  ears  {tinnitus  aurium)^  giddiness  and  vertigo  are  ex- 
perienced. Deafness  also  occurs,  as  the  effect  of  considerable 
doses,  and,  if  continued,  permanent  injury  may  result.  Poison- 
ous doses  cause  intense  headache,  dilated  pupils,  delirium,  coma 
and  convulsions. 

Peruvian  bark  and  its  alkaloids  are  the  most  reliable  tonics  and 
antiperiodics. 

Therapeutic  Uses. — Cinchona,  and  its  alkaloid,  quinine,  are  in- 
ternally employed  in  the  treatment  of  intermittent  fevers,  and 
also  other  fevers,  such  as  remittent,  typhus,  puerperal  and  scarlet ; 
also  in  influenza,  neuralgias  of  a  malarial  origin,  acute  rheumatism, 
phthisis,  advanced  stages  of  pneumonia  and  pleurisy,  erysipelas, 
urticaria,  diseases  of  the  eye,  epilepsy,  gangrene  and  mortification, 
scurvy,  pyemia,  malarial  dysentery,  passive  hemorrhages,  and  as 
an  anthelmintic,  etc.,  etc. 


348 


DENTAL  MEDICINE. 


Dose. — Of  powdered  cinchona,  9j  to  5iij>  given  in  infusion 
of  liquorice  ;  of  the  extract  of  cinchona,  gr.  j  to  gr.  x,  in  pill; 
of  sulphate  of  quinine,  gr.  j  to  3j. 

Dental  Uses. — Cinchona  and  its  alkaloid,  quinine,  are  em- 
ployed in  dental  practice,  in  the  treatment  of  neuralgia  of  the 
fifth  pair  of  nerves,  when  due  to  malaria,  in  from  five  to  ten 
grain  doses  of  quinine ;  in  aphthous  ulcerations,  in  one  or  two 
grain  doses  every  two  or  three  hours,  especially  when  there  is 
great  debility;  and  in  cancrum  oris;  also  in  the  form  of  gargles 
and  lotions,  in  gangrenous  ulcerations  of  the  mouth.  Cinchona 
is  also  employed  in  the  form  of  powder,  as  an  ingredient  of  cer- 
tain dentifrices,  for  its  tonic  and  antiseptic  properties. 


B- 


B. 


B 


M. 


DENTAL 
Dentifrice. 

Pulv.  cinchonse  flav.  .   z^  iv 
Pulv.  saponis  cas.  albi  5  iv 

Cretse  prep ^  ij 

Magnesise  calc.  ."   .    .  ^iij 

Otto  rosas gtt.  viij 

Olei  caryophylli     .    .  gtt.  vj 


Dentifrice. 
Pulv.  cinchona  flav.  .  ^iij 

Cretse  prep ^^  iij 

Sacchari  albi  .  .  .  .  ^  j 
Pulv.  cinnamomi  .  .  ^j 
Pulv.  saponis  cas.  albi  3  ij 
Pulv.  myrrhae  .    .    .    .  gj. 

For  Mercurial  Stomatitis. 
Dr.  Garrettson. 


M. 


Tinct.  cinchona  . 
Potassae  chloratis 
Sodae  bibor.  .  . 
Alumnis  pulv. 


Potassse  permanganatis  gr.  xxv 


Aquae  colonise 
Tinct.  myrrhae 
Tinct.  capsici 
Tinct.  krameriae 

Aquae 

SiGNA. — Use  as  a  gargle 


3y 

|ss 
3'J 


I) 

3i 

S  viij. 


FORMULA. 

Dentifrice. 

li .     Pulv.  cinchonae  flav.    .  ft.ss 

Cretae  prep Ib.ss 

Pulv.  myrrhae       .    .    .  ,5  iv 

Pulv.  radicis  iridis      .  ^jv.      M, 

For  Ulceration  of  Gums. 
R.     Pulv.  cinchonae    .    .    .  ^ij 

Cupri  sulph gr.  x 

Acaciae  (pulv.)    .    .    .  ^j 

Mellis ^i] 

Aquae  purae      .    .    .    .  3  iij.      M. 
SiGNA. — Apply    with     a    camel's-hair 
brush  to  ulcerated  surface  of  mucous 
membrane. 

For  a  IVash  after  the  Extraction  of 
Teeth. 

R.  Cinchonae  (decoct.)  .  f^ij 
Aluminae  ...  '  •  S'j 
Infus.  rosae     ....  f,^ij.       M. 

SiGNA. — Use  as  a  gargle. 

For  Digestive  Stimulation  in  Pyorrhaa 
Alveolaris. 
Dr.  Chas.  B.  Atkinson. 
R.     Cinchonidinae  sulph.    .  ^ss 
Acid,  sulph.  arom.  .    .  ^ij 
Alcohol  (95  per  cent.)    "^  iij 
M.  Aquae  dest,  q.  s.  ad.     .  J^  xv.    M. 

SiGNA. — One  teaspoonful  ter  die. 


CINNAMON.  34() 


CINNAMOMUM— CINNAMON. 
CASSIA    BARK. 

Source. — The  best  variety  of  cinnamon  is  obtained  from 
Ceylon,  and  is  the  prepared  bark  of  a  tree  of  the  natural  order 
Lauracea. 

It  is  in  the  form  of  long,  cylindrical  pieces,  thin,  smooth,  and 
of  a  yellow-brown  color,  with  a  fragrant  odor,  and  a  warm, 
sweetish,  aromatic  and  slightly  astringent  taste.  It  contains  a 
volatile  oil,  a  slight  amount  of  tannic  acid,  an  acid  peculiar  to 
itself,  chinamic  ac'id^  mucilage,  lignin,  etc. 

Medical  Properties  and  Action. — Cinnamon  is  an  aromatic 
stimulant  and  astringent,  being  more  powerful  as  a  local  than  as 
a  general  stimulant.  Its  medicinal  virtues  principally  reside  in  a 
volatile  oil,  oleum  cinnamomi. 

Therapeutic  Uses. — Cinnamon  is  chiefly  used  as  an  adjunct  to 
other  medicines,  being  seldom  prescribed  alone,  though  it  is 
capable  of  allaying  nausea  and  vomiting,  and  also  relieving 
flatulence.  Combined  with  chalk  and  with  other  astringents,  it 
is  well  adapted  for  the  treatment  of  diarrhoea.  A  strong 
decoction  of  cinnamon  made  by  boiling  one  pound  of  the  Ceylon 
sticks  in  a  closed  vessel  for  eight  hours  in  three  pints  of  water 
until  the  quantitv  is  reduced  to  one  pint,  is  recommended  by  Dr. 
Carne  Ross  for  the  pain  of  cancer.  Dose  is  one-half  pint  taken 
during  the  24  hours  soon  after  meals. 

Dose. — Of  cinnamon,  gr.  x  to  5ss  of  the  powder;  of  the 
tincture,  the  dose  is  foj  to  foiij- 

Oil  of  Cinnamon- — Oleum  Cinnamomi — is  obtained  by  dis- 
tillation, and  when  fresh,  is  of  a  light  yellow  color,  which 
becomes  deeper  by  age,  and  ultimately  red.  It  has  an  excessively 
hot,  pungent  taste.  It  is  often  employed  to  conceal  the  taste  of 
other  medicines,  and  is  a  powerful  local  stimulant.  Large  doses 
of  the  oil  of  cinnamon  are  poisonous,  producing  an  inflamed  and 
corroded  condition  of  the  gastric  and  intestinal  mucous 
membrane. 

Dose. — Of  the  oil  of  cinnamon,  gtt.  j  or  gtt.  ij,  administered 
in  the  form  of  an  emulsion. 


350  DENTAL  MEDICINE. 


Oil  of  Cassia. — The  oil  of  cassia  is  prepared  from  the  same 
order  of  tree  Lauracea. — Laurel,  but  not  from  the  same  tree  as 
the  oil  of  cinnamon,  as  the  cassia  is  a  distinct  species  from  the  true 
cinnamon.  Oil  of  cassia  is  secured  from  the  bud,  bark,  stem,  and 
leaves.     (See  Essential  Oils,  also  Antiseptics  in  Dental  Practice.) 

Cinnamon  water — Aqua  Cinnamomi — (cinnamon,  carbonate  of 
magnesia  and  distilled  water),  is  used  as  a  vehicle  for  other 
medicines. 

Spirit  of  cinnamon — Spiritus  Cinnamomi — (oil  of  cinnamon,  i 
part,  stronger  alcohol  15  parts).     Dose,  gtt.  x  to  gtt.  xx. 

Dental  Uses. — Cinnamon,  in  the  form  of  powder,  is  employed 
as  an  ingredient  of  dentifrices,  for  its  stimulant,  astringent  and 
aromatic  properties.  Oil  of  cinnamon  is.  also  employed  as  an 
ingredient  of  dentifrices,  for  its  stimulant,  astringent  and 
aromatic  properties,  and  for  the  relief  of  odontalgia.  One  drop 
applied  to  an  inflamed  dental  pulp  will  afford  temporary  relief;  it 
is,  also  used,  combined  with  iodoform,  in  the  treatment  of  alveolar 
pyorrhoea.  M.  Chamberland  asserts  that  no  living  germ  of 
disease  can  resist  the  antiseptic  power  of  essence  of  cinnamon 
for  more  than  a  few  hours.  It  is  said  to  destroy  microbes  as 
effectively,  if  not  as  rapidly,  as  corrosive  sublimate. 

DENTAL    FORMULA. 

For  Alveolar  Pyorrhoea.  por  Alveolar  Pyorrhcea,  Abscess,  etc. 

Dr.  a.  W.  Harlan.  ^r.  Black's  i.  2.  3.  Mixture. 

R.    Oil  of  cassia.    .    .    .    Ttlxij  ^^    O'l  °f '^i""^™^'^  ■    •    •»  P^-"' 

Distilled  water  .    .    .     5xvj  '^^'"^^l'^  ^^^'^  ('^''y''-)  ^  P^'"'' 

.    ..  .     r         J-        t    t-       r        r  Oil  of  gaultheria  .    .     3  parts,  M. 

Agitate  from  time  to  time  for  a  few  ^  -^  '^ 

days  at  a  temperature  of  70O    F.,  or  "^^   Sterilize   Softened  Dentine  over  a 

upward,   and   to   each   ounce   of    the  Nearly  Exposed  Pulp. 

above  add  :  Dr.  H.  A.  Smith. 

Officinal  dilute  sulphuric  acid  ITtv.  g  ^    Qil  of  cassia  ....    2  parts 

^^^''^  Carbolic  acid  ....    I  part 

SiGNA. — After    injecting   peroxide    of  Oil  of  cloves  ....     3  parts.    M. 

sodium,  inject  the  above  slowly.  Insert  permanent  filling  at  once. 

COCAINE. 
Source. — Cocaine  is  the  alkaloid  obtained   from  the  leaves  of 
the    Erythroxylon    Coca^  tl    shrub    indigenous  to  certain  parts  of 


COCAINE.  351 

South  America,  as  Peru  and  Chili.  The  leaves  resemble  those 
of  Chinese  tea,  and  in  the  preparation  of  the  alkaloid  it  is 
necessary  that  they  should  be  of  the  best  quality,  which  depends 
upon  their  being  gathered  at  a  proper  time,  carefully  dried  and 
not  injured  by  age  or  by  exposure  to  the  air,  as  moisture  deprives 
them  of  all  value.  Erythroxylon  Coca  is  different  from  choco- 
late or  Theobroma  Cacao.  Pure  cocaine  is  in  the  form  of 
transparent  prisms,  without  smell,  bitter  to  the  taste,  soluble  in 
seven  hundred  parts  of  cold  water,  more  soluble  in  alcohol,  and 
entirely  soluble  in  ether.  The  solution  has  an  alkaline  reaction, 
and,  when  applied  to  the  tongue,  it  imparts  a  bitter  taste,  and  a 
certain  insensibility,  followed  by  a  slight  sensation  of  cold,  recall- 
ing the  effect  of  ether  spray  upon  the  epidermis.  Heated  to 
208°  F.,  the  cocaine  becomes  liquid,  and  under  the  influence  of 
cold,  it  becomes  a  transparent  mass,  which  gradually  assumes  a 
crystalline  form.  If  it  be  exposed  to  a  higher  heat  than  208°  F., 
cocaine  changes  its  color  and  decomposes.  It  is  inflammable, 
and  burns  with  a  brilliant  flame,  leaving  an  ash.  It  forms 
soluble  salts  with  acids  (its  hydrochlorate  is  one  of  the  best),  and 
all  these  salts  are  more  bitter  than  the  alkaloid.  It  is  a  com- 
pound of  carbon,  hydrogen,  nitrogen  and  oxygen.  The  chemical 
composition  of  the  alkaloid  is  C,7H2iN04 ;  its  reaction  is 
strongly  alkaline. 

The  hydrochlorate  of  cocaine  is  generally  employed  in  surgery, 
and  is  in  the  form  of  a  white  crystalline  powder,  which  is  spar- 
ingly soluble  in  water,  but  readily  soluble  in  alcohol,  ether,  oil 
and  vaseline.  At  first  a  2  per  cent,  solution  was  used,  but  sub- 
sequently it  was  increased  to  four,  five,  ten  and  twenty  per  cent. 

Medical  Properties  and  Physiological  Action. — Dr.  Niemann,  of 
Goslar,  as  early  as  i860,  noted  the  fact  that  cocaine,  when  ap- 
plied to  the  tongue,  produced  local  anaesthesia,  but  his  investiga- 
tions, as  well  as  those  of  others  at  a  later  period,  appear  to  have 
been  forgotten,  until  1884,  when  Dr.  Koller,  of  Vienna,  demon- 
strated the  action  of  cocaine,  in  solution,  on  the  eye. 

Locally  applied  to  the  mucous  membrane,  cocaine  acts  as  an 
anaesthetic,  the  blanching  of  the  membrane  being  followed  by 
marked  congestion.     It  has  a  powerful  action  on  the  eye  on  ac- 


352  DENTAL  MEDICINE. 


count  of  the  delicacy  of  the  conjunctiva,  which  it  readily  pene- 
trates, and  thus  paralyzes  the  peripheral  nerve-endings.  The 
anaesthesia  is  produced  in  from  one  to  five  minutes  according  to 
the  strength  of  the  solution  used,  and  is  accompanied  by  marked 
dilatation  of  the  pupil.  Applied  to  the  peripheral  sensory  nerves  it 
paralyzes  them ;  its  action  is  manifested  first  upon  the  sensitive 
fibres  and  then  upon  the  motor  fibres.  Poisonous  doses  of 
cocaine  cause  convulsions  of  cerebral  origin,  both  clonic  and 
tetanic.  Taken  internally  cocaine  stimulates  the  muscles,  in- 
creasing muscular  povver  temporarily,  especially  after  starvation 
or  fatigue.  It  acts  as  a  stimulant  to  the  heart  and  circulation  in 
moderate  doses,  and  also  as  a  povtrerful  respiratory  stimulant,  and 
in  poisonous  doses  it  destroys  life  by  failure  of  the  respiration 
with  exhaustion  from  the  convulsions.  Cocaine  increases  the 
bodily  temperature  if  given  in  large  doses,  due  to  an  increase  of 
heat-production  ;  but  in  moderate  doses  it  has  no  such  effect. 

Cocaine  is  eliminated  by  the  kidneys,  but  is  chiefly  dissipated 
by  oxidation  in  the  body. 

Therapeutic  Uses. — Cocaine  is  an  efficient  local  anaesthetic  in 
all  cases  where  it  can  come  in  contact  with  the  nerve  filaments 
in  sufficient  concentration.  It  is  also  employed  in  some  forms  of 
insanity,  melancholia,  neurasthenia,  gastralgia  and  in  wasting  dis- 
eases, pruritic  skin  affections  and  hoarseness.  The  leaves  in 
cigarettes  have  relieved  hay  fever  and  throat  affections.  Cocaine 
is  employed  as  a  local  anaesthetic  and  local  anodyne  in  all  painful 
affections  of  the  eye,  the  operation  for  cataract,  etc.,  but  the 
evidence  as  to  its  reliability  in  such  deep  operations  as  iridectomy, 
squint,  etc.,  is  conflicting.  (There  are,  however,  cases  reported 
by  Dr.  Konigstein  of  even  the  surfaces  of  the  eyelids  entirely 
losing  their  sensitiveness  when  hydrochlorate  of  cocaine  was  ap- 
plied in  solid  form.)  It  is  also  employed  in  painful  affections  of 
the  pharynx  and  larynx,  or  of  any  other  excitable  mucous  mem- 
brane or  of  nerve  tissue.  Prof.  Engle  reports  a  case  of  trigeminal 
neuralgia  successfully  treated  by  hypodermic  injections  of  the 
hydrochlorate  of  cocaine.  Dr.  Wagner,  of  Vienna,  basing  a 
theory  upon  the  established  principle  that  fluids  move  from  the 
positive  to  the  negative  pole  in  a  galvanic  current,  saturated  the 


COCAINE.  353 

positive  electrode  with  a  strong  cocaine  solution,  applied  it  to  the 
skin  and  applied  the  negative  pole  a  short  distance  from  the  posi- 
tive, and  found  that  incisions  could  be  made  u^ithout  producing 
any  pain.     (See  Cataphoresis.) 

Cocaine  is  locally  applied  in  stomatitis  before  cauterizing  the 
affected  area  of  membrane,  also  in  soreness  and  tenderness  of  the 
gums,  in  pharyngitis,  and  in  coryza  and  hay  fever,  in  the  form  of 
a  powder  combined  with  morphine  and  bismuth,  which  is  snuffed 
into  the  nostrils  ;  also  in  minor  surgery,  such  as  amputation  of 
the  fingers,  etc.,  etc.  Schleich's  infiltration  ancesthesia  consists  in 
injecting  into  the  skin,  as  superficially  as  possible,  a  solution  of 
common  salt,  cocaine,  and  morphine  to  produce  local  anssthesia^ 
and  thereby  pressure  on  the  nerve-filaments,  which  are  also  de- 
pressed by  the  cold  liquid  coming  in  contact  with  them  ;  and  the 
local  anemia  so  caused  assists  in  destroying  sensation.  Whereas 
cocaine  is  soluble  in  fats,  its  salts  are  not,  hence  cocaine  itself 
should  only  be  used  in  anaesthetic  salves  or  ointments.  Internally 
administered,  cocaine  or  the  fluid  extract  of  coca  is  of  service  in 
low  fevers  as  a  supportive  and  stimulant;  in  the  vomiting  of 
pregnancy,  and  other  forms  of  severe  emesis,  as  it  depresses  the 
gastric  sensory  nerves,  thus  decreasing  the  irritability  of  the 
stomach.  It  is  also  employed  for  the  opium  habit,  but  if  given 
largely  may  induce  the  cocaine  habit.  The  cocaine  habit  is  more 
liable  to  occur  among  patients  who  are  informed  of  the  nature  of 
the  remedy  used  and  especially  is  this  the  case  when  it  is  em- 
ployed internally  for  medicinal  purposes.  Individual  susceptibility 
to  the  toxic  influence  of  cocaine  is  a  complication  of  sufficiently 
frequent  occurrence  to  surround  the  use  of  the  drug  with  due  care 
and  caution  ;  but  it  is  not  a  contra  indication  to  its  employment 
as  an  anaesthetic. 

Dose. — The  dose  of  the  fluid  extract  {Extractwn  Cocce  Fluidum^ 
is  from  yi  to  2  drachms.  The  dose  of  Cocaine  is  from  ^  to  i/^ 
grain.  The  dose  of  the  Hydrochlorate  of  Cocaine  is  i  to  3^ 
grain. 

A  point  of  considerable  importance  in  using  cocaine   hypoder- 
mically  is  to  make  use  of  a  perfectly  aseptic  syringe  ;  for  frequently 
in  cases  where  the  drug  is  so  used  and    suppuration  follows,  it  is 
23 


354  DENTAL  MEDICINE. 


the  fault  of  want  of  cleanliness  in  this  particular,  and  not  to  the 
employment  of  the  drug. 

The  quantity  of  cocaine  required  to  produce  anaesthesia  varies 
with  the  operation  and  its  extent;  as  a  rule  for  ordinary  minor 
operations  from  25  to  40  minims  of  a  four  per  cent,  solution  are 
needed.  The  length  of  time  necessary  for  the  production  of 
local  anaesthesia  or  insensibility  under  cocaine  varies  from  three  to 
ten  minutes. 

Dr.  Bier,  of  Kiel,  quite  recently,  claimed  that  by  throwing  small 
quantities  of  very  dilute  cocaine  solutions  into  the  spinal  canal, 
the  nerves  are  affected  at  their  roots,  and  the  lower  part  of  the 
body  is  rendered  completely  insensible  to  pain,  the  effect  lasting 
about  three-quarters  of  an  hour.  Very  curiously,  perception  of 
heat  and  cold,  as  well  as  of  touch  and  pressure,  are  not  affected. 
Severe  operations,  it  is  claimed,  have  been  satisfactorily  per- 
formed, but  the  after-effects — such  as  dizziness,  severe  headache 
and  vomiting — are  quite  as  unpleasant  and  more  prolonged  than 
those  following  chloroform  and  ether. 

Dental  Uses. — In  operations  in  the  mouth,  affecting  the 
mucous  membrane  and  the  immediately  subjacent  tissues,  the 
salts  of  cocaine  have  proved  efficient  for  their  local  anaesthetic 
and  anodyne  effects.  But  for  operations  on  deep-seated  tissues, 
such  as  are  involved  in  the  extraction  of  teeth,  the  action  of  pure 
cocaine  is  not  certain  in  its  practicable  benefits.  Cocaine  has, 
however,  proven  very  efficient  in  relieving  the  pain  of  the  surgi- 
cal treatment  of  alveolar  pyorrhoea,  the  extirpation  of  the  pulps 
of  teeth,  and,  in  some  cases,  that  of  hypersensitive  dentine.  Ex- 
posed pulps  are  rendered  less  painful  after  being  treated  with  a 
five  per  cent,  solution  of  cocaine,  to  which,  in  some  cases, 
morphine  has  been  added.  In  some  cases  also,  it  is  claimed, 
highly  inflamed  pulps  have  been  successfully  capped,  as  an  ex- 
periment, with  a  paste  of  cocaine  and  glycerine,  although,  as  was 
foreseen,  the  anaesthetic  did  not  arrest  the  course  of  the  pulpitis. 
In  treating  hypersensitive  dentine,  the  more  sensitive  the  struc- 
ture the  stronger  the  solution  of  cocaine  to  be  employed.  The 
pure  cocaine  in  the  form  of  crystals,  of  the  hydrochlorate  or 
other  salts,  has   proven   efficient  when   applied   to  hvpersensitive 


COCAINE.  355 

dentine.  For  the  extirpation  of  pulps  of  teeth,  it  is  recom- 
mended first  to  anaesthetize  the  pulps  superficially,  with  a  paste 
of  cocaine  and  glycerine,  and  then  to  introduce,  by  means  of  a 
syringe,  a  twenty  per  cent,  solution  of  cocaine  directly  on  the 
exposed  portion  of  the  pulp,  when  it  can  be  removed  with  a 
nerve  extractor  without  causing  any  pain.  Dr.  John  S. 
Marshall,  from  his  experiments  with  the  pills  of  citrate  of  co- 
caine, found  that  under  favorable  circumstances,  the  citrate,  in 
such  a  form,  produces  anaesthesia,  when  applied  to  sensitive 
dentine,  in  from  five  to  ten  minutes,  and  that  the  obtunding 
effect  is  of  a  duration  sufficient  for  the  preparation  of  the  cavity. 
He  was  also  able  to  extirpate  the  pulp  of  the  tooth,  after  the 
citrate  had  been  applied,  in  from  three  to  twelve  minutes.  In 
using  the  citrate  in  the  form  of  pills,  one  pill  is  introduced  into 
the  sensitive  cavity,  and,  after  being  secured  with  a  pledget  of 
cotton,  moistened  in  tepid  water,  is  permitted  to  remain  from 
five  to  twelve  minutes.  Dr.  Marshall  suggests  the  use  of 
granules,  containing  one-sixteenth  of  a  grain  of  pure  citrate  of 
cocaine,  instead  of  pills  containing  glycerine  and  saccharine 
matters.  A  solution  of  the  salts  of  cocaine  has  also  been  sub- 
cutaneously  injected,  with  favorable  results,  for  the  relief  of  the 
pain  resulting  from  periodontitis  and  hypercementosis ;  and  Dr. 
Hillischer  recommends  the  rubbing  in  of  cocaine,  either  in  sub- 
stance or  in  concentrated  solution,  after  the  epithelium  has  been 
macerated  with  tincture  of  iodine,  to  promote  absorption,  and 
thus  relieve  the  pain  of  chronic  periodontitis ;  also  the  repeated 
application  of  the  concentrated  solution  to  relieve  the  ulcers  of 
thrush,  aphthae,  etc.  In  the  surgical  treatment  of  alveolar 
pyorrhoea,  the  pain  may  be  relieved  by  first  applying  dilute  alco- 
hol to  the  gums,  by  means  of  a  camel's-hair  brush,  and  then  in 
the  same  manner,  a  ten  per  cent,  solution  of  cocaine,  repeating 
the  application  of  the  cocaine  once  or  twice  during  the  space  of 
five  minutes.  The  slowness  of  the  action  of  cocaine  is  a  great 
objection  to  its  use  as  an  anaesthetic. 

The  four  per  cent,  or  five  per  cent,  solution  applied  to  a  tooth 
unprotected  by  a  rubber  dam  (as  the  rubber  prevents  the  anaes- 
thetic action  of  the  agent),  for  the  space  of  twenty  minutes,  re- 


356  DENTAL  MEDICINE. 


peating  the  application  if  necessary,  is  recommended  by  Dr. 
Thompson.  Dr.  A.  W.  Harlan  recommends  a  solution  com- 
posed of  cocaine  hydrochlorate  ten  grains,  in  sulphuric  ether, 
ninety  minims,  which  is  to  be  applied  for  four  or  five  minutes, 
for  the  painless  extirpation  of  an  exposed  pulp. 

Dr.  Harper  recommends  the  following  method  for  removing 
pulps  of  teeth  by  the  use  of  crystals  of  cocaine  :  "  Take  a 
drop  of  the  oil  of  cloves  and  add  enough  cocaine  to  make  a 
thick  paste  and  introduce  it  into  the  pulp,  after  having  first  put 
the  rubber  dam  on  the  tooth  ;  then  with  a  broach  slowly  work  it 
down  ;  with  a  bur  open  up  the  opening  slowly,  and  in  ten  or  fif- 
teen minutes  the  pulp  may  be  removed  from  any  of  the  anterior 
teeth."  Where  arsenic  has  been  applied  to  the  pulp  and  the 
patient  returns  with  pain,  relief  will  be  obtained  from  the  appli- 
cation of  cocaine. 

Herhst's  Obtundent  consists  of  a  saturated  solution  of  cocaine 
hydrochlorate  in  chemically  pure  sulphuric  acid,  to  which  sul- 
phuric ether  is  added  to  the  point  of  saturation,  the  excess  of  the 
ether  floating  upon  the  surface  and  evaporating.  Several  appli- 
cations are  necessary  to  produce  anaesthetic  eff^ects,  and  seventy 
grains  of  cocaine  hydrochlorate  are  required  to  saturate  two 
drachms  of  the  sulphuric  acid. 

Cocaine,  owing  to  the  unsatisfactory  results  which  have  at- 
tended its  use  as  a  topical  application,  is  now  generally  applied  by 
hypodermic  injection,  for  the  extraction  of  teeth.  Owing  to  the 
necessity  for  introducing  the  agent  deeply  into  the  tissues,  Dr. 
Walb's  method  is  to  inject  a  two  per  cent,  solution  of  the  hy- 
drochlorate of  cocaine  hypodermically  over  the  root  of  the  tooth 
to  be  extracted,  the  injections  being  usually  made  on  each  side 
of  the  gum,  above  the  root  of  the  tooth,  and  as  many  as  the 
number  of  teeth  to  be  extracted  mav  indicate;  the  same  method 
is  employed  for  obtunding  hypersensitive  dentine,  and  in  remov- 
ing pulps.  The  full  anaesthetic  effect  is  developed  in  from  five 
to  ten  minutes,  and  continues  ten  or  fifteen  minutes.  It  has  also 
been  suggested  to  hypodermically  inject  the  solutions  of  cocaine 
upon  both  the  lingual  branch  and  the  inferior  dental  branch  of 
the  inferior  maxillary  nerve,  the  former  being  preferred  by  some. 


COCAINE.  357 


on  account  of  its  supplying  the  alveoli  and  gums  ;  but  greater 
success  appears  to  result  from  injecting  the  gum  on  each  side  of 
the  tooth.  Dr.  Raymond  recommends  charging  the  syringe  with 
thirteen  minims  of  a  four  per  cent,  solution  of  cocaine,  and  to 
direct  the  needle-point  on  a  line  extending  about  midway  be- 
tween the  angle  and  the  coronoid  process  of  the  inferior  maxillary., 
passing  through  the  internal  pterygoid  muscle,  and,  using  the 
finger  on  the  external  oblique  line  as  a  guide,  to  carry  the  needle 
point  along  inner  surface  of  ramus  until  the  nerve  is  reached, 
where  it  enters  the  inferior  dental  foramen,  for  operations  on  the 
inferior  molar  teeth. 

Dr.  Raymond  also  suggests  the  following  method  of  preparing 
and  applying  cocaine:  Obtain  a  quantity  of  the  soluble  alkaloid, 
and  mix  it  at  the  time  of  using  it  (as  it  deteriorates  when  long 
kept).  The  requisites  are  a  minim  glass,  pair  of  scales,  some 
filtering  paper,  and  a  little  water  that  has  been  boiled.  It  is 
necessary  to  have  an  easy-working  syringe,  with  a  perfectly 
smooth,  sharp  needle.  Care  must  be  taken  to  exhaust  the  air 
from  the  syringe  when  charged  ready  for  use.  This  can  be  done 
by  drawing  in  more  of  the  solution  than  is  needed,  and  pressing 
it  out  to  the  required  number  of  minims.  Hold  the  needle  point 
up,  so  as  to  allow  the  air  to  get  above  the  solution,  then  press 
the  piston. 

The  needle  of  the  hypodermic  syringe  should  be  fine,  sharp 
and  clean,  and  rendered  thoroughly  aseptic  previous  to  its  em- 
ployment, which  may  be  accomplished  by  drawing  up  through  it 
a  few  drops  of  any  good  antiseptic  solution,  such  as  strong  car- 
bolic acid,  and  the  solution  should  be  freshly  prepared  for  each 
operation  as  the  salts  of  cocaine  rapidly  decompose  ;  or  the 
needle  of  the  syringe  can  be  immersed  in,  and  the  barrel  filled 
with,  boiling  water  rendered  alkaline  by  the  addition  of  a  small 
quantity  of  bicarbonate  of  soda.  The  salt  should  be  dissolved  in 
slightly  warm  water,  and  the  strength  of  the  solution  vary  from 
5  to  20  per  cent.  A  five  per  cent,  solution  is  made  by  dissolv- 
ing ^  grain  of  cocaine  in  lo  minims  of  water.  Previous  to  the 
injection,  the  gum  should  be  dried  about  the  tooth,  and  a  folded 
napkin  so  placed   as  to  exclude  the  saliva.     All  air  must  be  ex- 


358  DENTAL  MEDICINE 


pelled  from  the  syringe,  and  the  gum  at  the  point  the  needle  of 
syringe  is  to  enter,  should  be  obtunded  by  applying  a  few  drops  of 
the  solution  to  the  mucous  membrane,  so  as  to  render  the  punc- 
ture painless.  It  is  recommended  to  inject  the  solution  at  three 
points,  two  punctures  on  the  labial  or  buccal  surface,  and  one  on 
the  palatine  or  lingual  surface.  The  point  of  the  needle  should 
be  inserted  about  one-sixth  of  an  inch  below  the  free  margin  of 
the  gum,  and  pressed  in  obliquely,  upwards  or  downwards,  as  the 
case  may  be,  in  a  direction  towards  the  apex  of  the  tooth,  until 
the  point  of  the  needle  rests  against  the  bone ;  all  of  the  soft 
tissues  must  be  penetrated.  With  the  needle  in  position,  and  a 
finger  placed  on  either  side  and  pressed  with  some  force  against 
the  gum  to  keep  the  tissues  in  place,  the  solution  should  be 
slowly  injected,  when  the  gum  should  appear  completely  blanched 
in  the  neighborhood  of  the  puncture.  After  injecting  the  solu- 
tion the  needle  should  not  be  withdrawn  for  several  seconds,  and 
then  a  finger  should  be  placed  over  the  puncture  to  prevent  anv 
escape  of  the  solution.  Some  six  or  seven  minutes  elapse  before 
the  full  anaesthetic  effects  of  the  cocaine  are  obtained.  Dr.  Gask 
recommends  placing  a  few  crystals  of  the  salt  just  around  the 
neck  of  the  tooth  to  render  painless  the  application  of  the  forceps, 
and  he  prefers  for  injection  hydrochlorate  of  cocaine  in  the  form 
of  half-grain  tabloids.  Rinsing  the  mouth  with  hot  water  before 
the  injection  of  cocaine  solution,  and  again  afterwards,  and  re- 
peating the  injection,  is  a  method  which  is  attended  with  satis- 
factory results. 

The  best  syringe  for  hypodermic  use  consists  of  one  made  alto- 
gether of  metal  with  no  leather  packing  as  this  is  unclean.  The 
metal  piston  is  accurately  ground  to  fit  the  metal  barrel,  and  the 
piston  should  be  touched  with  glycerine  before  using  the  syringe, 
as  this  is  easily  washed  off.  Such  a  syringe  can  be  boiled  with- 
out the  slightest  injury,  which  should  be  done  every  time  it 
is  used. 

The  combined  use  of  cocaine  and  chloroform  is  advocated  by 
Obolinski,  who  injects,  either  before  or  after  the  anaesthesia  is 
obtained,  from  one  to  three  centigrammes  of  cocaine  ;  or  he  in- 
jects in  the  neighborhood  of  the  seat  of  operation,  and  during  its 


COCAINE.  359 

progress,  from  three  to  seven  centigrammes.  Cocaine  is  thus 
used  on  the  ground  that  it  is  a  complete  antagonist  to  chloroform, 
of  which,  however,  there  is  some  doubt,  as  cocaine  is  rather  a 
general  excitant  of  the  central  nervous  gray  matter  than  a  direct 
and  powerful  stimulator  of  the  heart,  while  its  stimulant  effect 
upon  respiration  is  not  to  be  depended  upon.  Obolinski  claims 
that  this  mixed  narcosis  requires  the  use  of  less  chloroform,  that 
vomiting  is  prevented,  and  that  there  are  few  disagreeable  after- 
effects. Dr.  Gordon  White  recommends  a  saturated  solution  of 
cocaine  hydrochlorate  in  ether  as  an  excellent  preparation  for 
sensitive  dentine  and  pulp-extirpation.  (See  Vapocaine.)  A 
mixture  of  cocaine  and  guaiacol  in  crystalline  form,  made  into  a 
thick  paste,  is  recommended  for  hypersensitive  dentine. 

Dr.  A.  C.  Gask  recommends  painting  the  palate  with  a  five 
per  cent,  solution  of  cocaine  for  obtaining  impressions  of  mouths 
which  exhibit  great  intolerance  to  the  introduction  of  all  impres- 
sion materials;  also  a  20  per  cent,  solution  applied  to  the  mucous 
membrane  on  cotton,  for  service  in  wedging  and  separating  teeth, 
in  forcing  silk,  etc.,  up  in  high  conical  edges,  in  removing  por- 
tions of  overhanging  gum,  in  lancing  abscesses,  in  treating 
alveolar  pyorrhoea,  in  extirpation  of  pulps,  and  in  the  treatment 
of  teeth  very  sensitive  from  periodontitis;  also  in  the  form  of  a 
i^  grain  compressed  tabloid  placed  in  the  cavity,  to  relieve  the 
pain  following  extraction. 

Dangers  of  Cocaine. — The  dangers  from  the  use  of  cocaine  are 
enumerated  as  follows :  Certain  persons  possess  an  idiosyncrasy 
to  cocaine,  which  cannot  be  foreseen  or  entirely  guarded  against; 
it  exerts  its  toxic  effects  upon  the  nervous  centres  and,  second- 
arily, the  heart;  its  evil  effects  are  most  liable  in  neurotic  sub- 
jects ;  the  danger  in  cocaine  poisoning  is  mainly  from  paralysis 
of  the  heart,  syncope ;  special  care  is  necessary  in  "  weak  heart  " 
and  organic  heart  disease ;  many  regard  its  subcutaneous  admin- 
istration as  dangerous,  and  that  it  should  be  avoided ;  the  use  of 
the  strongest  solutions  is  dangerous  and  unnecessary ;  that  it  may 
be  well  to  precede  its  use  by  the  administration  of  alcohol  or 
other  cardiac  stimulant,  as  is  done  with  chloroform. 

Patients  of  a  sanguine  temperament  and  in  good  health  are  the 


360  DENTAL  MEDICINE. 


most  favorable  subjects  in  the  use  of  cocaine  ;  while  the  nervous, 
hysterical,  and  those  exhibiting  great  dread  of  the  impending 
operation,  as  well  as  pregnant  women,  may  be  regarded  as  un- 
favorable subjects.  Great  care  should  also  be  taken  to  prevent 
even  the  weakest  solution  of  cocaine  from  running  down  into  the 
fauces,  and  restorative  agents  should  always  be  at  hand. 

Cocaine  appears  to  be  absorbed  with  extraordinary  rapidity, 
and  the  stronger  the  solution  which  is  locally  applied,  the  greater 
the  danger  of  toxic  symptoms.  The  rapidity  of  the  absorption 
varies  in  the  different  tissues,  absorption  occurring  most  rapidly 
through  the  conjunctiva,  then  through  the  nose,  larynx,  mouth 
and  ear.  A  ten  per  cent,  solution  is  sufficiently  strong  for  most 
purposes,  and  is  less  dangerous  than  one  of  greater  strength. 

Treatment  of  Cocaine  Poisoning. — The  treatment  of  cocaine 
poisoning  consists  of  measures  to  rouse  the  heart,  especially 
ighalations  of  the  nitrite  of  amy!,  and  such  restoratives  as 
brandy,  whiskey,  aromatic  spirits  of  ammonia,  strychnine, 
atropine,  digitalis,  ether  and  chloroform  (when  convulsions 
are  present),  or  five  minims  of  carbonate  of  ammonia  by 
injection.  The  hot  baths,  hot  drinks,  and  hot  sinapisms 
over  the  heart,  and  friction  are  often  serviceable;  also  artifi- 
cial respiration.  M.  Elroy  recommends  flagellation  with  wet 
towels,  massage,  and  artificial  respiration,  if  asphyxia  threat- 
ens ;  inhalations  of  chloroform  against  tetanization  of  the  res- 
piratory muscles ;  where  there  is  great  pallor  to  provoke  vaso- 
dilatation, and  to  diminish  the  encumberment  of  the  central  cir- 
culation by  the  inhalation  of  amyl  nitrite.  If  these  means  prove 
ineffectual  and  deglutition  is  impossible,  give  hypodermic  injec- 
tions of  caffein  and  of  sulphuric  ether  (15,  30,  even  45  minims). 
M.  Chouppe  recommends  in  addition  the  hypodermic  injections 
of  morphine,  but  only  in  the  very  outset,  and  as  large  as  from 
one-half  to  five-eighths  of  a  grain. 

Efforts  should  be  made  to  moderate  the  reflex  excitability  of 
the  nervous  system,  sustain  the  heart,  and  reestablish  the  equilib- 
rium of  the  blood-pressure. 

Dr.  Curtis  recommends  a  preparation  called  volasem  as  an 
antidote  to  the  effect  of  cocaine. 


COCAINE.  361 

Cocaine  is  also  employed  in  combination  with  arsenious  acid 
for  a  pulp-devitalizing  mixture.  (See  Arsenious  Jcid.)  One 
grain  of  cocaine  to  one-eighth  ounce  of  chloroform  is  employed 
for  extirpating  pulps  without  pain. 

Cocaine  Incompatibles. — When  combined  with  nitrate  of  silver, 
decomposition  of  the  hydrochlorate  occurs  with  the  formation  of 
an  insoluble  chloride  of  silver,  and  a  corresponding  change  in  the 
cocaine.  If  calomel  and  hydrochlorate  of  cocaine  are  rubbed 
together,  chemical  reaction  begins.  Added  to  mercuric  oxide, 
an  irritating  instead  of  an  anaesthetic  action  is  produced,  due  to 
the  formation  of  oxychloride  of  mercury. 

Test  for  Presence  of  Cocaine. — H.  Carlton  Smith  gives  the  fol- 
lowing simple  test :  "  To  a  solution  of  cocaine  was  added  a  few 
drops  of  ferric  chloride ;  the  iron  was  reduced  as  usual ;  then  the 
addition  of  a  single  drop  of  stannous  chloride  produced  a  white 
precipitate.  This  disappeared  upon  shaking,  but  one  or  two 
more  drops  of  the  chloride  of  tin  reproduced  it,  and  this  time  it 
was  permanent." 

Vapocaine  consists  of  a  fifteen  per  cent,  solution  of  cocaine 
hydrochlorate  in  ethyl  ether,  and  is  employed  as  a  dentinal  anaes- 
thetic. It  is  neutral  to  litmus  paper  and  is  the  production  of  an 
ethereal  solution  of  a  cocaine  salt.  It  is  principally  used  as  an 
obtundent  for  sensitive  dentine,  and  it  is  claimed  for  it  that  as 
aqueous  solutions  of  cocaine  salts  fail  to  penetrate  the  dentine, 
and  the  ethereal  solution  of  cocaine  alkaloid  is  deficient  in  anaes- 
thetic property,  an  ethereal  solution  of  a  cocaine  salt,  besides  pos- 
sessing anaesthetic  properties,  will  secure  the  maximum  of  anaes- 
thesia with  the  use  of  a  minimum  amount  of  cocaine.  Vapocaine 
possesses  great  penetrating  power,  which  is  due  to  the  fact  that 
the  heat  of  the  mouth  vaporizes  a  portion  of  the  ether,  and  drives 
the  natural  fluid  of  the  tooth  out  of  the  tubuli,  thus  securing  a 
rapid  distribution  of  the  remaining  portion  throughout  the  tooth 
structure.  From  this  portion  the  ether  is  dissipated,  leaving  the 
cocaine  salt  distributed  in  minute  subdivisions  throughout  the 
tubuli.  The  cocaine  is  then  redissolved  by  the  natural  fluid  of 
the  tooth,  securing  a  rapid  and  effective  anaesthetic.  By  its  use 
the  natural  moisture  of  the  tooth  is  made  to  act  as  a  solvent  for 


362 


DENTAL  MEDICINE. 


the  cocaine,  thus  obviating  the  delay  which  occurs  when  a  watery 
solution  of  cocaine  is  allowed  to  diffuse  throughout  the  tooth. 
The  following  is  the  method  for  using  vapocaine  :  Apply  the 
rubber  dam  and  dry  the  cavity  with  hot  air  before  applying  vapo- 
caine. Then  place  a  piece  of  dry  absorbent  cotton  in  the  cavity 
and  drop  the  vapocaine  on  this  until  thoroughly  saturated.  Leave 
this  in  from  two  to  five  minutes,  keeping  the  cotton  saturated 
until  ready  for  operation.  It  is  preferable  to  cover  the  cotton 
with  a  piece  of  rubber  dam  in  order  to  prevent  the  too  rapid 
evaporation  of  the  ether.  Repeated  applications  of  the  vapocaine 
are  made  after  a  portion  of  the  decayed  dentine  is  first  removed, 
and  during  this  operation,  and  the  dentinal  tubuli  being  free,  the 
vapocaine  permeates  the  entire  tooth  structure.  It  requires  a  few 
minutes  to  produce  a  good  result.  It  acts  quickly  in  some  teeth, 
and  slowly  in  others.  It  is  supposed  to  penetrate  the  dentinal 
tububli  chiefly  by  thermal  energy  rather  than  by  capillary  attrac- 
tion, the  evaporation  of  the  ether  causing  pressure,  which  drives 
the  moisture  out  of  the  tubuli  and  forces  the  vapocaine  in.  The 
ether  being  evaporated  by  the  heat  of  the  mouth,  a  deposit  of 
cocaine  remains  in  the  tubuli,  and  is  then  dissolved  by  the  natural 
fluid  of  the  tooth  again  filling  the  tubuli. 

DENTAL    FORMUL-ffi, 


To  Make  a  Solution  of  Hydrochlorate 

of  Cocaine.    (4  per  cent.) 
R.    Cocaini  hydrochloratis 

(cryst.) gr.  18.228 

Aqu£e  destillatae  .    .    .   f^^j.       M. 

For  Painless  Extraction  as  a  Local 
AtJcEsthetic. 
Dr.  Clyde  Paine. 
R.    Cocaine     .... 
Glycerine    .    .     . 
Nitro  glycerine    . 
Atropia  sulph.  .    . 
Carbolic  acid    ....  gtt.iij.    M. 
Distilled  water  to  make  ^  ij. 
SiGNA. — By  injection  hypodermically, 


gr.xv 

gr-j 
gtt.iij. 


For  Exposed  Pulps, 
R.    Cocaini   hydrochloratis 

(cryst.) gr.vj 

Spiritus  mentlijE  pip.  .  f^j.       M. 
SiGNA. — Apply  on  a  pledget  of  cotton. 

For  Local  Anesthesia. 
Dr.  H.  J.  McKellops. 
R.    Mur.  cocaini    ....  gr.iss 
Spts.  alcoholis  .    .    .    .  ^'] 
Chloroformi ^j.        M. 

For  Neuralgia  and  Odontalgia. 
R.    Cocaini  hydrochloratis 

(cryst.) gr.vj. 

Menthol gr.xxx 

Alcoholis  q.  s.  ad.  .    .   f^j.       M. 


COCAINE. 


363 


SiGNA. — Apply  as   a   lotion,  or   on   a 

pledget  of  cotton. 

Chloroform  or  bromide  of  ethyl  may 
be  substituted  for  the  alcohol. 

To  Make  Oleate  of  Cocaine, 
(5  per  cent.) 
R.    Cocaini  (alkaloid)  .    .  gr.2^ 
Acidi  oleic  (pure)  .    .  Tllxx 
Olei  amygdalae    .    .    .  TlX-^l- 
Dissolve   the   alkaloid   in    the  oleic 
acid  and  add  the  almond  oil. 

For  Pain  of  Difficult  Dentition. 

M.  VlQUIER. 

K.    Cocaini  hydrochloratis  gr.ij 

Syrup  simp 3  ijss 

Tinct.  saffron    ....   gtt.x.      M. 
SiGNA. — Rub    the    painful    gums   fre- 
quently during  the  day. 

For  Local  A77CBstfiesia. 
Dr.  J.  M.  Lewis. 
R .    Cocaini  hydrochloratis  grs.viii 
Chloralishydrat.  .    .    .   gr.v 
Acidi  carbolici     .    .    .   gtt.iij 

AquEe  destil ^^S'U-    M. 

SiGNA. — Inject   2  or  3  drops  into  the 
gum  at  one  time. 

For  Hypersensitive  Dentine. 
R .    Cocaini  hydrochloratis 

(cryst.) gr.x 

Tragacanth,  glyceritum  q.s. 
Form  a  mass. 
SiGNA. — Insert    a   minute    portion   in 
cavity  half  an  hour  before  operating. 
For  Neuralgia  and  Odontalgia. 
R .    Cocaini  hydrochloratis 

(cryst.) gr-xv 

Olei  caryophylli  .    .    .   f^j.      M. 
SiGNA. — Apply  as   a   lotion,  or   on   a 
pledget  of  cotton. 

Local  Ancesthetic. 
R .    Cocaini  hydrate  (4  per 

cent,  solution)  .  .  .  ^iij 
Carbolic  acid  ....  gtt.v 
Chloral  hydrate     .    .    .  gr.v.     M. 


SiGNA. — Use     hypodermically   around 
tooth  with  care. 

Local   Ancesthetic  for   Extraction    of 
Teeth. 
Dr.  J.  W.  Hope. 
R .    Cocaini  hydrochlo- 
ratis   5  parts 

Acidi  carbolici  ....  6  parts 
Camphorae  (pine  gum)  6  parts 
Alcoholis  (95  per 

cent.)  q.  s.  to  make  1 20  parts  M. 
SiGNA. — Inject  with  a  hypodermic  syr- 
inge I  to  3  minims  deeply  into  inner 
and  outer  surfaces  of  gum.  Apply 
over  the  gum  absorbent  cotton  satu- 
rated with  the  solution.  Wait  4  or 
5  minutes. 

Local  Anastketic  for  Gums  and  Sensi- 
tive Dentine. 
Dr.  Martin. 

R.    Cocaini Z'^-H 

Antipyrin g'"-vj 

Aq.  destil 1T|.xvj.  M. 

Prof.  J.  E.  Michael  suggests  2  grains 
of  acetanilid  as  a  substitute  for  the 
antipyrin. 

For  Stomatitis  and  Difficult  Teething 

of  Children. 

INTERNAT.    KLIN.    RUNDSCHAU. 

1.  Paint  the  gums  with  the  follow- 
ing mixture  : 

R.    Cocaini  mur gr.iss 

Sodii  chlor gr-xv 

Glycerini, 

Aquae  dest aa  ^iiss 

2.  Spray  a  boracic  acid  solution  on 
the  inflamed  parts. 

3.  To  prevent  spasms  give  internally  : 
R .    Potassii  brom.    .    .    .  gr.xv 

Syr.  alth ^v 

Salep.  gummos.     .    .  ^j-^ij-    M. 
SiGNA. — Teaspoonful  every  hour. 


364 


DENTAL  MEDICINE. 


For  Irritation  of  the  Gums. 
Dr.  M.  F.  Besnier. 
R.    Hydrochlorate  of  co- 
caine   gr.| 

Bromide  of  potassium  gr.vii  ss 

Distilled  water, 

Glycerine aaTTLcl.  M. 

For  Hypersensitive  Dentine. 
Dr.  D.  Genese. 
R.    Cocaine  hydrochlor.  4  per  cent. 
Carbolic  acid  ...  50  per  cent. 
Benzoin  gum  ...  50  per  cent. 

Local  AncESthetic. 
Dr.  N,  S.  Hoff. 

B.    Cocaini Z'^-Yz 

Morphinae  sulph.  .    .  gr.^ 
Atropine  sulph.  .  .    .  gr.^^j 
Sterilized  water  ....  gtts.xxx.  M. 
SiGNA. — Inject  hypodermically  gtts.  v 

to  XV. 

Local  Obtundent  or  Ancesthetic. 
Dr.  a.  C.  Hewitt. 
B .    Cocaini  hydrochlorat.  grs.Cxx 

Atropin gx.-^ 

Strophanthin  .   .    .    .  gr.^ 
Beta  naphthol    .    .    .  gr.x 
Oil  of  cloves, 
Oil  of  cassia  .    .    .    .  aa  3  ij 

Glycerine ^^^j-      M. 

SiGNA. — Apply  for  all  operations  about 
the  gums,  as  with  an  applicator. 

Local  AncESfhetic. 
Dr.  W.  T,  Martin. 
R.    Hydr.  cocaini    .    .    .  grs.x 
Sulph.  atropin    .    .    .  gr.^'j 
Aquae  dist., 
Listerine aa^iv.    M. 


SiGNA. — Inject    into  surrounding   soft 
tissues,  and  wait  5  to  20  minutes. 

Local  Obtundent. 
Dr.  C.  N.  Peirce. 

R .    Cocaine gr.v 

Carbolic  acid  ....  grs.xx 

Chloroform ^ss 

Muriatic  acid  ....  tTt'^ 
Alcohol 3ij.         M. 

Local    Obtundent  for    Exposed 

Pulps,  etc. 

Dr.  Bethel. 

R.    Carbolic  acid  (crystals)  grs.x 

Gum  camphor  ....  grs.viij 

Iodoform grs.v 

Local   Obtundent  for  Exposed  Pulps, 
Sensitive  Dentine,  and  about  Necks 
of  Teeth. 
R .    Acid,  carbolic    .    .    .  gr.xx 
01.  sassafras  .    .    .    .  tl^xxx 
Oleate  cocaine  (4  per 

cent.) Ttt^^ 

Local  Ancesthetic, 
Dr.  C.  V.  Snelgrove. 
R .    Cocaini  hydrochlorate  gr.v 
Acid,  carbolic  ....  gr.iv 
Gum  camphor  ....  gr.vj 
Glycerine,  pure    .    .    .  gr.xv 
95  per  cent.  spts.  vini 

rect.  q.  s.  ad.     .    .    .  ^ij 

For  Nausea  from  Wearing  Plates. 

R.    Cocaine grs.viij 

Syrup  tolu ^  ss 

Whiskey i^iij 

Water Oj.        M. 

SiGNA.  — To  spray  mouth. 


CocAiNUM  Phenylicum  consists  of  a  combination  of  cocaine 
and  phenyl,  the  univalent  radical,  CgH^  of  phenol.  It  is  a  light- 
colored  substance  resembling  and  of  the  consistence  of  thick 
honey.     It  melts  readily,  dissolves  in   alcohol  30  to  50  per  cent. 


MEADOW   SAFFRON.  3^5 


and  contains  75  per  cent,  of  the  alkaloid  cocaine.  It  is  used 
locally  in  a  strength  of  one-tenth  per  cent.,  and  appears  to 
possess  the  same  qualities  as  carbolic  acid.  It  has  been  recom- 
mended in  the  place  of  muriate  of  cocaine. 

COLCHICUM— MEADOW  SAFFRON. 

Source. — Colchicum  root — Colchici  radix;  Colchicum  seed — 
Colchici  semen^  the  bulb  and  seed  of  the  Colchicum  Autumnali. 
Colchicum  contains  tannic  and  gallic  acids  and  an  alkaloid 
known  as  colchicine.,  which  is  the  active  principle  ,•  colchicum  also 
contains  starch,  sugar  and  gum.  It  has  a  bitter  taste,  and 
imparts  its  medicinal  virtues  to  water,  alcohol,  ether ;  wine  and 
vinegar  extract  all  its  properties. 

Medical  Properties  and  Therapeutic  Uses. — Colchicum,  in  the 
forms  of  fluid  extract,  wine  and  tincture,  increases  the  mucous 
and  glandular  secretions  of  the  stomach,  intestines,  liver,  kidneys 
and  skin,  and  causes  an  increased  flow  of  saliva,  and  also  of 
urine.  A  large  dose  may  produce  heat  in  the  epigastrium, 
nausea,  vomiting,  depression  of  the  circulation,  muscular  feeble- 
ness and  pain  in  the  head,  large  watery  stools  and  an  increased 
secretion  of  biliary  matters.  In  poisonous  doses  it  produces  all 
the  symptoms  of  an  irritant  poison,  such  as  acute  pain  in  abdo- 
men, profuse  waterv  and  mucous  discharges,  suppression  of 
urine,  cold  extremities  and  feeble  pulse  ;  also  muscular  cramps, 
in  some  cases.  Colchicum  is  principally  employed  in  gout, 
when  a  quantity  sufficient  to  shorten  the  duration  of  an  acute 
attack  and  reduce  the  swelling  by  an  increased  secretion  from  the 
skin,  intestines  and  kidneys,  is  only  required.  It  is  often 
combined  with  an  alkali,  such  as  aromatic  spirits  of  ammonia, 
bicarbonate  of  potassium,  or  carbonate  of  magnesia,  to  increase 
its  effect.  The  active  principle,  colchicine.,  is  generally  more 
efficacious  than  the  crude  colchicum.  It  is  very  serviceable  in 
rheumatic  gout  when  combined  with  alkalies,  and  also  in  all 
alfections  dependent  upon  a  gouty  diathesis,  such  as  constipation, 
congestion  of  the  liver,  and  headache  from  torpor  of  the  portal 
circulation.  It  is  now  rarely  used  in  acute  rheumatism,  but  in 
chronic  rheumatism   it  often  proves  serviceable.     Its  use  is  indi- 


366  DENTAL  MEDICINE. 


cated  in  plethora,  constipation  and  deficient  action  of  the  liver, 
kidneys  and  skin. 

Dose. — Of  the  fluid  of  colchicum  root — Extractutn  Colchici 
Radicis  Fluidum.^  1TLij  to  TTLv.  Of  wine  of  colchicum  root — 
Vinum  Colchici  Radicis^  TTlv  to  TTLxxx.  Of  acetous  extract  of 
colchicum  root — Extractum  Colchici  Radicis^  gr.  ss  to  gr.  ij.  Of 
tincture  of  colchicum  (seed) — Tinctura  Colchici^  Hlx  to  5j- 

COLLODIUM— COLLODION. 

Derivation. — Collodion  is  a  solution  of  4  parts  of  pyroxylin 
in  70  parts  of  stronger  ether,  and  26  parts  of  alcohol.  Pyroxy- 
lin or  gun  cotton  is  prepared  by  adding  a  mixture  of  nitric  and 
sulphuris  acids  to  cotton  freed  from  impurities. 

Collodion  is  a  colorless,  syrupy,  and  very  inflammable  liquid, 
with  a  strong  ethereal  odor.  By  long  standing  and  exposure, 
or  when  applied  to  a  surface,  it  deposits  a  thin,  transparent 
and  strongly  contractile  film,  which  is  insoluble  in  water  or 
alcohol.  It  should  be  kept  in  glass-stoppered  bottles.  It  is  ap- 
plied by  means  of  a  camel's-hair  brush.  When  it  becomes  too 
thick,  it  may  be  diluted  by  a  solution  consisting  of  ether,  3  parts, 
alcohol,  I  part. 

Medical  Properties  and  Action. — It  is  serviceable  as  an  emol- 
lient, and  its  action  is  mechanical,  as  it  draws  together  and  holds 
in  apposition  divided  parts,  and  protects  such,  as  well  as  abraded 
or  denuded  surfaces,  from  contact  with  the  air.  As  the  ether  it 
contains  evaporates,  the  surface  of  the  part  to  which  it  is  applied 
is  constringed,  and  a  degree  of  pressure  is  thus  established,  which 
is  very  useful  in  moderating  vascular  action,  promoting  absorp- 
tion, and  changing  the  course  of  pus  which  may  already  be 
formed  into  a  direction  more  desirable.  On  account  of  the 
liability  of  collodion  to  crack  and  peel  off,  these  objections  have 
been  obviated  by  the  use  of  what  is  known  as  Flexible  Col- 
lodion—  Collodium  Flexile — (collodion,  92  parts,  Canada  turpen- 
tine, 5  parts,  castor  oil,  3  parts),  which  is  softer  and  more  pliable 
and  elastic. 

Therapeutic  Uses. — Collodion  is  very  useful  in  ulcers,  fissures, 
incised  wounds,  abraded  surfaces,  erysipelas,  skin  diseases,  etc. 


COLLODION.  3G7 


Dental  Uses. — Collodion  is  a  very  useful  application  in  dental 
practice,  to  prevent  alveolar  abscesses  from  discharging  externally 
on  the  face  ;  for  such  a  purpose,  it  is  applied  in  successive  layers, 
so  as  to  act  as  a  compress,  and,  bv  moderating  the  vascular 
action,  cause  absorption,  or  such  a  change  in  the  direction  of 
the  discharge  as  will  induce  it  to  open  in  the  mouth.  It  is  also 
employed  in  combination  vi'ith  carbolic  acid,  as  an  application 
for  odontalgia ;  when  introduced  on  cotton,  it  acts  as  a  temporary 
tilling  ;  it  has  also  been  employed  for  arresting  the  mucous 
secretion  during  the  operation  of  filling  cavities  near  to  or  under 
the  margin  of  the  gum,  but  the  rubber  dam  has  superseded  it  in 
this  respect.  Combined  with  iron  and  other  agents,  it  forms  a 
styptic  preparation. 

In  the  dental  laboratory,  collodion,  in  the  form  of  a  colored 
preparation,  is  employed  to  coat  the  surfaces  of  the  plaster 
models  of  plastic  work,  and  when  not  applied  too  thick,  it  pro- 
tects the  plaster  surface,  and  also  prevents  an  unsightly  rubber 
surface  on  that  part  of  the  plate  which  is  adapted  to  the  mucous 
surface  of  the  mouth.  When  this  preparation  becomes  too  thick 
for  use,  it  may  be  diluted  with  a  solution  of  3  parts  of  ether  to 
I  part  of  alcohol. 

Collodion  is  precipitated  by  carbolic  acid. 

Cantharidal  Collodion — Collodium  cum  Cantharide — is 
composed  of  cantharides  (Spanish  flies),  in  powder  60  parts, 
flexible  collodion,  85  parts,  commercial  chloroform,  q.  s.  The 
addition  of  one  per  cent,  of  Venice  turpentine  to  cantharidal 
collodion  will  prevent  the  disagreeable,  and,  at  times,  painful 
contraction  of  the  preparation  on  drying. 

Like  cantharides,  cantharidal  collodion,  when  locally  applied, 
excites  inflammation  of  the  skin  and  mucous  membrane,  which 
terminates  in  a  copious  secretion  of  scrum  under  the  cuticle. 
It  produces  a  blister  in  the  same  time  as  an  ordinary  blistering 
plaster,  and  is  applied  with  greater  facility,  and  is  better  adapted 
to  cover  uneven  surfaces,  and  retains  its  place  more  certainly. 
It  acts  much  more  readily  if  the  evaporation  of  the  ether  is 
prevented  by  a  piece  of  oiled  silk  placed  over  the  surface  im- 
mediately after  the  application  of  the  collodion. 


368  DENTAL  MEDICINE. 

Dental  Uses. — Cantharidal  collodion  is  a  valuable  application 
in  periodontitis,  applied  to  the  gum  over  the  root  of  the  affected 
tooth,  by  means  of  a  camel's-hair  brush,  previously  removing  all 
moisture  from  the  surface,  and  protecting  the  lips  and  cheeks, 
until  the  ether  it  contains  has  evaporated,  and  an  artificial  cuticle 
is  formed.  The  blister  which  rises  on  the  gum  should  be 
punctured  with  a  needle.  The  counter-irritation  thus  produced 
relieves  the  periosteal  inflammation. 

Iodized  Collodion — Collodium  lodicum — (collodion,  .5j.  iodine, 
gr.  xx)  forms  a  good  solution  of  iodine  for  external  use. 

DENTAL    FORMULi^. 
For  Odontalgia.  For  a  Styptic. 

R .     Acidi  carbolic!  cryst.,  B  •     CoUodii 3  iij 

Collodii aa  gj.     M.  Tinct.  ferri  perchloridi    jj 

SiGNA.— To  be  applied  on  cotton.  Olei  ricini  •    •    •    .    .  gtt.  ij.      M. 

SiGNA. — To  be  applied  to  the  bleeding 
For  a  Styptic.  surface,  or,  on  cotton,  to  the  alveolar 

R.     Collodii     .    .    .    .partes  100  *^^^'^y- 

Acidi  carbolici     .  partes    10  Po''  "■  Styptic. 

Acidi  tannici    .    .  partes      5  R .     Acidi  tannici, 

Acidi  benzoici  .      partes     5    M.  Alcoholis, 

SiGNA. — To  be  applied  to  the  bleeding  ^theris  .    .    .    .  aa  parts  aeq.  M. 

surface  by  means  of  a  camel's-hair  Then  add  as  much  pyroxylin  as  the 

brush.  solution  will  dissolve. 

Crystallin  is  the  name  of  a  collodion,  in  which  methyl 
alcohol  takes  the  place  of  ethyl  alcohol.  Crystallin  differs  from 
ordinary  collodion  in  that  it  does  not  dry  so  quickly  :  it  leaves  a 
thin  transparent  cuticle,  and  a  pure  article  of  methyl  alcohol 
should  be  employed  in  preparing  it  to  prevent  the  unpleasant, 
penetrating  odor  of  impure  alcohol.  Philip  recommends  the 
following  formula  for  '•^Jiex'tble  crystallin." 

R .         Castor  oil 4  parts 

Canada  balsam 2  parts 

Crystallin 40  parts. 

Crystallin  varnish,  impervious  to  air,  can  be  prepared  as  follows: 

R .         Crystallin 30  parts 

Castor  oil 4  parts 

Zinc  oxide 8  parts. 


HEMLOCK. 


369 


CONIUM— HEMLOCK. 

Derivation. — Hemlock  is  the  fruit  of  the  Conium  Maculatum^ 
or  spotted  (not  the  common)  hemlocic,  which  is  an  umbelliferous 
plant.  The  principal  one  of  its  three  alkaloids  is  coninejCgHjjN, 
which  is  very  powerful. 

Medical  Properties  and  Action. — Conium  is  a  depressing  a2;ent 
producing  motor  paralysis,  first  causing,  as  the  effects  of  a  large 
dose,  nausea  and  vomiting  with  a  general  weakness  of  the  volun- 
tary muscles,  but  with  no  direct  action  on  the  heart.  In  fatal 
cases  of  poisoning  death  follows  from  paralysis  of  the  respiratory 
muscles  causing  asphyxia.  The  antidotes  are  nux  vomica,  picro- 
toxin,  and  active  muscular  exercise.  It  is  quickly  decomposed 
by  heat. 

Therapeutic  Uses. — Conium  is  employed  in  mania,  chorea, 
tetanus,  hydrophobia,  whooping-cough,  asthma,  laryngismus, 
stridulus,  diseases  of  the  eye  and  strychnine  poison.  For  nerve- 
pain  with  muscular  spasm,  the  best  results  may  be  expected  from 
the  combined  administration  of  morphine  and  conine,  subcuta- 
neously  applied,  as  the  effects  of  conine  are  greatly  heightened  by 
morphine.     Conium  is  also  used  in  dislocations  to  relax  muscles. 

Dose. — Of  Abstractum  conii,  gr.  ss  to  gr.  ij ;  Extractum  conii 
alcoholicum,  gr.  ij  to  gr.  iv;  Extractum  conii  fluidum,  Ulij  to 
ITlv ;  Tinctura  conii,  TTlx  to  f5j  ;  Conine,  TIIto  to  Tllij. 

Dental  Uses. — Conium  is  employed  in  neuralgia,  locally  ap- 
plied ;  inflamed  dental  pulps;  also  in  cases  of  artificial  teeth 
lodging  in  the  oesophagus,  to  produce  relaxation  of  the  muscles. 

CORYL. 

Derivation. — Coryl  is  a  mixture  of  chloride  of  methyl  and 
chloride  of  ethyl.  It  is  kept  liquid  under  a  pressure  of  three  at- 
mospheres in  a  recipient  called  a  "  Coryleur,"  which  is  a  small 
nickel-plated  metallic  tube,  easily  managed  with  a  stop-cock, 
which  allows  the  regulation  of  the  escape  of  the  vapor  of  the 
compound.  In  using  it,  the  tube  must  be  kept  in  a  horizontal 
position.  It  is  a  colorless  liquid  of  an  ethereal  odor  and  taste, 
and  is  obtained  by  a  methylation  of  chloride  of  ethyl. 

Therapeutic  Action. — Coryl  is  a  refrigerating  local  anaesthetic, 
less  powerful  -than  chloride  of  methyl,  and  not  so  liable  to  cause 
•24 


370  DENTAL  MEDICINE. 


an  eschar;  it  is,  however,  more  powerful  than  chloride  of  ethyl, 
and  produces  a  deeper  state  of  insensibility.  It  is  as  inflammable 
as  chloride  of  ethyl,  and  boils  at  32°  F.  Coryl  will  produce 
complete  anaesthesia  in  15  to  20  seconds;  and  to  apply  it  the 
patient  is  directed  to  breathe  by  the  nose,  and  not  by  the  mouth  ; 
he  must  then  rinse  his  mouth  with  water  at  the  temperature  of 
the  room  ;  the  gum  must  be  dried  and  the  jet  of  coryl  applied  to 
the  mucous  membrane  below  the  crown  of  the  tooth  to  be  ex- 
tracted. Beginning  at  the  apex  of  the  root  and  carrying  the  jet 
upward  toward  the  neck  of  the  tooth,  then  over  the  crown,  and 
down  on  the  inner  side  of  the  alveolus  up  to  the  end  of  the  root, 
then  coming  back  again  over  the  same  parts,  and  repeating  this 
for  15  or  20  seconds,  when  the  anaesthesia  will  be  found 
complete.  To  obtain  a  deeper  and  more  prolonged  state  of 
insensibility,  as  soon  as  a  first  application  of  the  coryl  is  made, 
the  mouth  must  be  quickly  rinsed  with  water;  then  another 
application  is  made,  followed  by  another  rinsing  of  the  mouth, 
and  finally  a  third  application,  when  the  anaesthesia  will  be  found 
to  last  over  40  minutes. 

CREASOTUM— CREASOTE. 

Specific  Gravity:    1. 08. 

Derivation. — Creasote  is  a  product  of  the  distillation  of  wood- 
tar,  and  is  a  mixture  of  several  phenols,  such  as  carbolic  acid, 
creasol,  CgHi^Og,  and  cresylol,  C^pHgO.  Its  name  is  derived 
from  the  Greek  kpsa^,  "  flesh,"  and  ffcuTrj'-^  "  preserver,"  as 
animal  substances,  when  saturated  with  it,  are  preserved  from 
putrefaction.  It  is  also  obtained  from  crude  pyroligneous  acid. 
When  derived  from  wood-tar,  creasote  principally  consists  of 
such  phenols  as  guaiacol^  creasol^  methyl-creasol,  and  phloral. 
The  best  form  of  creasote  for  medicinal  use  is  made  from 
beech-wood. 

Creasote,  when  fresh  and  pure,  is  a  colorless,  oleaginous  fluid, 
with  a  strong  empyreumatic  odor,  resembling  closely  carbolic 
acid,  and  a  caustic,  burning  taste  ;  when  made  from  beech-wood 
creasote  is  of  a  reddish,  amber  color.  After  exposure,  it  has  a 
yellowish  or  brownish  tinge.     Its  purity  may  be  tested  by  strong 


CREASOTE.  371 


acetic  acid,  which  dissolves  the  creasote,  and  leaves  behind  the 
impurities  floating  above  the  creasote  solution.  It  may  also  be 
tested  by  dropping  it  on  paper,  when,  if  pure,  it  will,  after  being 
volatilized  by  heat,  leave  no  stain.  Creasote  may  be  dis- 
tinguished from  carbolic  acid,  which  it  closely  resembles  in  many 
respects,  in  being  less  caustic,  and  by  not  imparting  a  blue  color 
to  a  piece  of  pine  wood  dipped  first  into  an  alkaline  solution  of 
creasote,  and  then,  after  drying,  into  muriatic  acid. 

Combined  with  the  tincture  of  the  chloride  of  iron,  an 
alcoholic  solution  of  creasote  will  develop  a  deep,  greenish-blue 
color,  while  carbolic  acid  with  the  same  tincture  produces  a  light 
brown.  According  to  the  U.  S.  Dispensatory,  creasote  power- 
fully coagulates  albumen. 

Medical  Properties  and  Action. — Creasote  is  stimulant,  seda- 
tive, rubefacient,  escharotic,  styptic  and  antiseptic.  It  possesses 
the  property  of  immediately  coagulating  albumen,  and  to  this 
property  is  ascribed  many  of  its  effects  on  the  living  system.  In 
large  doses  it  is  an  acro-narcotic  poison  ;  but  in  small  doses,  it  is 
styptic  and  astringent,  and  for  the  latter  property  it  is  more 
generally  administered  than  for  any  other.  When  creasote 
comes  in  contact  with  the  blood,  the  latter  changes  from  a  bright 
red  to  a  reddish-brown  color,  with  small  spots  of  coagulated 
albumen  and  it  also  becomes  thicker.  Applied  to  the  tongue,  it 
causes  severe  pain,  but  without  redness  or  tumefaction  ;  it  also 
causes  a  strong  taste  of  smoke,  and  a  copious  flow  of  saliva. 
When  administered  internally  in  small  doses,  it  causes  a  sen- 
sation of  warmth  in  the  stomach,  and  exercises  a  decided  sedative 
action.  In  large  and  poisonous  doses  it  produces  profound 
stupor,  flushed  countenance,  fixed  eyes,  slow  and  labored  pulse, 
irritable  stomach,  nausea,  vertigo,  but  has  no  effect,  such  as  dila- 
tation or  contraction,  on  the  pupils.  The  treatment  in  cases  of 
poisoning  by  creasote  consists  in  administering  albumen,  such  as 
white  of  eggs,  milk  or  wheat  flour;  also  the  administration  of 
ammonia  and  other  stimulants,  mustard,  emetics,  etc.  Death 
from  creasote  is  caused  by  its  coagulating  the  albumen  of  the 
blood,  and  preventing  its  circulation  through  the  arterial  system. 

Therapeutic  Uses. — Creasote  is  administered  internally  for  gas- 


372  DENTAL  MEDICINE. 


trie  irritability  and  vomiting,  flatulence,  diarrhoea,  diabetes,  hemop- 
tysis, pulmonary  consumption,  chronic  bronchitis,  epilepsy,  neu- 
ralgia, etc.  Externally,  it  is  applied  to  ulcers,  eruptions,  diseases 
of  the  skin,  wounds,  hemorrhage  from  wounds  or  leech  bites, 
warts ;  also  in  putrid  sore  throat,  as  a  gargle. 

Dose. — Of  creasote,  gtt.  j  or  gtt.  ij,  several  times  a  day,  either 
in  mucilage,  in  the  proportion  of  half  a  fluid  ounce  to  a  drop  of 
the  creasote;  or  it  may  be  given  in  pill  form.  For  external  use, 
from  gtt.  ij  to  gtt.  vj,  or  more  may  be  added  to  a  fluid  ounce  of 
water. 

Creasote  Water. — Jqua  Creasoti  (creasote,  oj^  distilled  water, 
Oj).     Dose  of  creasote  water,  f5j  to  f5iv. 

Solidified  Creasote. — For  the  purpose  of  making  the  appli- 
cation of  creasote  to  the  teeth  more  convenient,  and  preventing 
the  effects  upon  the  mucous  membrane  of  the  mouth  when  apply- 
ing it  to  carious  cavities  in  teeth,  a  gelatinous  solidity  may  be 
given  to  it  by  adding  lo  parts  of  collodion  to  15  parts  of  creasote. 

Dental  Uses. — Creasote,  like  carbolic  acid,  is  a  valuable  agent 
in  dental  practice,  although  the  use  of  the  latter  has,  in  some  re- 
spects, superseded  that  of  the  former,  the  two  being  very  similar 
in  their  action,  with  some  advantages  in  the  case  of  carbolic  acid. 
Creasote  is  employed  for  the  relief  of  odontalgia,  obtunding  the 
sensitiveness  of  dentine,  alveolar  abscess,  periodontitis,  suppura- 
ting pulps  of  teeth,  devitalizing  pulps  of  teeth,  treatment  of  ex- 
posed pulps  of  teeth,  mercurial,  and  other  forms  of  stomatitis, 
ulcers  of  the  mouth,  diseases  of  the  gums ;  as  a  styptic  for  hem- 
orrhage from  the  gums,  mucous  membrane  and  leech  bites,  and 
after  the  extraction  of  teeth.  Creasote,  like  carbolic  acid,  has  a 
peculiar  power  as  an  antiseptic,  hence  it  is  a  valuable  application 
in  cases  attended  with  offensive  purulent  discharges.  It  promotes 
the  growth  of  healthy  granulations,  and  hastens  the  healing  of 
wounds,  and  arrests  the  process  of  suppuration.  Properly  diluted 
in  the  form  of  a  gargle,  creasote  in  sloughs  of  the  mouth  or  throat 
stimulates  the  ulcer  to  healing  and  corrects  fetor  of  the  breath. 
When  applied  to  ulcerated  surfaces,  it  should  be  repeated  as  pus 
is  formed,  or  fungous  growths  appear.  It  is  a  painful  escharotic 
upon  mucous  membrane,  with,  however,  a  soothing  reaction. 


CREASOTE. 


373 


For  the  treatment  of  exposed  pulps  it  is  employed  either  diluted 
or  in  its  full  strength  ;  for  periodontitis  and  alveolar  abscess,  in 
its  full  strength,  or  in  combination  with  such  agents  as  glycerine, 
iodine,  etc. ;  also  in  devitalized  teeth,  and  as  an  antiseptic  appli- 
cation in  ulceration  of  the  mouth,  and  recession  of  gums  from  the 
necks  of  the  teeth.  When  used  as  a  styptic  after  the  extraction 
of  teeth  it  is  applied  on  lint  or  cotton,  with  pressure ;  and  diluted 
with  water  it  is  employed  in  the  treatment  of  caries  and  necrosis 
of  the  maxillary  bones.  To  dilute  it  for  injections  it  is  often 
mixed  with  alcohol,  and  the  strength  reduced  by  adding  water. 
Mixed  with  an  equal  quantity  of  oil  of  cloves  its  odor  and  taste 
are  modified.  Creasote  is  also  employed  to  neutralize  any  acid 
remaining  in  the  cavity  of  a  tooth  about  to  be  filled,  and  to  harden 
and  render  imperishable  the  contents  of  the  dentinal  tubuli,  for 
which  purpose  it  is  applied  to  the  walls  of  the  cavity  on  a  pellet 
of  cotton.  Equal  quantities  by  bulk  of  creasote  and  oil  of  cloves 
are  applied  to  aching  teeth,  painful  gums,  ulcerous  surfaces,  and 
also  where  pulps  are  not  exposed  ;  also  for  saturating  cavities  be- 
fore the  insertion  of  fillings,  as  a  disinfectant  and  coagulant. 

An  ointment —  Unguentum  Creasoti — is  composed  of  creasote 
10  parts,  lard  90  parts,  and  is  useful  in  cutaneous  affections. 


For  Pulpitis. 
Dr.  Garretson. 

R.     Creasoti gtt-^j 

Tinct.  iodinii  .  .  .  .  ^j 
Liq.  plumb,  subacetat.  ^j 
Chloroformi, 

Tinct.  opii aa  ^  ss.  M. 

SiGNA. — Apply  on   cotton  to  exposed 
surface  of  pulp. 

For  Alveolar  Abscesses. 
R .     Creasoti, 

Linimenti  iodi,  partes  Eequales.  M. 
SlGNA. — To  be  used  as  an  injection. 

For  Odontalgia. 

R.     Creasoti 5SS 

Camphorse gr.x.       M. 


DENTAL    FORMULA. 

SiGNA. — To  be  applied,  on  a  pellet  of 
cotton,  to  carious  cavity. 


For  Odontalgia. 


R 


Creasoti ^ij 

Morphinge  acetatis  .    .  gr.xx.     M. 
SiGNA. — To  be  applied,  on  cotton,  to 
carious  cavity. 


For  Odontalgia. 


R. 


Creasoti, 
Chloroformi, 

Liquidi  opii  .    .    .    .  aa  ^  iij 
Tinctura  benzoini  .    .    .  Jj.      M. 
SiGNA. — To  be  applied,  on  a  pellet  of 
cotton,  to  carious  cavity. 


374  DENTAL  MEDICINE. 


For  Odontalgia. 

U .        Creasoti, 

Chloroformi, 

Morphinse  hydrochloratis iiii  H  "J 

Tinctura  benzoini 5J.         M. 

SiGNA. — To  be  applied,  on  a  pellet  of  cotton,  to  carious  cavity.     (See  formulae 
of  Carbolic  Acid.) 


GuAiACOL  is  a  derivation  of  wood  creasote,  in  the  form  of  an 
oily  liquid  with  an  odor  of  cassia  and  resorcin. 

The  liquid  guaiacol  found  in  commerce  is  far  from  being 
a  chemically  pure  product.  It  is  a  mixture  of  cresylol,  guaiacol 
and  creasote  in  varying  proportions.  It  may  contain  50  per  cent, 
guaiacol,  but  sometimes  it  contains  no  more  than  20  or  even  10 
per  cent.  Pure  guaiacol  is  in  the  form  of  hard,  white  rhomboidal 
crystals,  almost  insoluble  in  water,  but  soluble  in  alcohol,  in  oil, 
and  in  anhydrous  glycerine. 

The  taste  of  guaiacol  is  slightly  sweetish,  with  a  pungent  and 
burning  after-taste.  The  chief  effects  of  poisoning  with  pure 
guaiacol  are,  agitation  and  then  enfeeblement  with  retardation  of 
the  heart's  action,  and  of  the  breathing.  Most  of  the  secretions, 
and  especially  the  lachrymal,  are  increased  in  quantity.  Death 
occurs  during  coma.  Synthetic  guaiacol  has  been  administered 
in  various  stages  of  consumption,  taken  immediately  before  eat- 
ing.    Large  doses  may  cause  vomiting. 

The  oily  liquid  possesses  the  active  principle  of  creasote,  and 
the  power  to  destroy  microbes  in  the  human  mouth.  It  is 
claimed  to  possess  the  same  therapeutic  value  as  creasote  and  to 
be  a  better  disinfectant,  especially  in  cases  of  decomposed  pulps. 
"  Guaiacol  may  be  sealed  up  in  a  pulp  cavity  from  one  to  three 
months  or  more,  and  the  contents  be  found  perfectly  disinfected." 

CREOLIN— CREOLINE— KREOLIN. 

Creolin  is  a  liquid  cresol,  a  product  of  the  decomposition  of 
coal  tar. 

Derivation. — It  is  obtained  from  English  pit-coal  by  distilla- 
tion, and   is   in   the  form  of  a  brownish,  syrupy  liquid,  complex 


KREOLIN.  375 


and  very  impure,  with  an  odor  liice  tar  ;  and  in  its  impure  state 
is  slightly  irritating,  slightly  caustic  and  strongly  acid,  and  re- 
sembles in  its  properties  the  phenols.  A  purified  preparation  of 
creolin  is,  however,  as  neutral  as  vaseline,  and  quite  as  inoffen- 
sive to  man  and  animals.  It  is  slightly  soluble  in  water,  but 
soluble  in  ether,  chloroform,  and  absolute  alcohol ;  in  the  form 
of  an  emulsion  it  is  as  efficacious  as  an  antiseptic  as  a  true  solu- 
tion. 

Therapeutic  Uses  and  Medical  Properties. — Creolin  is  both  anti- 
septic, germicide  and  hemostatic,  being  employed  for  the  latter 
purpose  in  obstetrical  practice  ;  it  is  also  used  in  tonsilitis.  It  is 
employed  with  great  benefit  in  ulcers  of  the  cornea.  Its  germi- 
cidal power  is  somewhat  below  that  of  carbolic  acid.  Its  anti- 
septic properties  are  powerful,  and  it  is  not  irritating  nor  poison- 
ous. It  is  soluble  in  alcohol  and  glycerine,  and  it  does  not  affect 
the  skin  nor  corrode  instruments,  and  the  odor  of  the  purified 
preparation  is  not  disagreeable.  It  appears  to  have  an  anodyne 
effect,  and  is  curative  when  applied  to  open  wounds.  Creolin 
has  also  been  employed  in  antral  disease.  An  aqueous  solution 
of  creolin  is  made  of:  ^.  Creolin,  gr.  iss ;  aquae  destil.,  TTLcl, 
which   may  be  applied  with  a  brush  or  in  the  form  of  spray. 

Dental  Uses.—Yor  dental  use  it  may  be  injected,  or  applied  on 
floss-silk  or  cotton  wool.  Creolin  is  considered  to  be  a  good 
deodorizer  of  iodoform.  One  or  two  drops  of  creolin  may  be 
added  to  half  a  glass  of  water  for  a  mouth  wash,  to  correct  dis- 
agreeable odors  from  the  teeth  and  mouth.  It  will  also  hold  in 
check  acid-producing  germs;  it  is  also  recommended  for  its  ac- 
tion on  mucous  surfaces  in  soft  and  congested  mouths,  and  to 
correct  acid  conditions,  and  in  the  treatment  of  fistulous  tracts  of 
suppurating  surfaces ;  also  in  root  canals  to  deodorize  dead  tissue. 
It  will  also  remove  the  rust  on  instruments  when  applied  by 
means  of  a  felt  wheel  on  a  lathe.  To  sterilize  instruments  a  two 
per  cent,  solution  may  be  used ;  also  on  the  hands,  and  a  one  per 
cent,  solution  for  irrigation  of  wounds  and  treatment  of  mucous 
surfaces. 


376  DENTAL  MEDICINE, 


DENTAL    FORMULA. 

For  Alveolar  Pyorrhcea, 
Dr.  a.  W.  Harlan. 

R.        Creolin jj 

Sodium  fluo.   silicate gr.xx 

Olei  cassiae TTLxx 

Glycerins; 5  iv.  M. 

Dilute  with  water  to  suit. 
SiGNA. — Use   as  a  mouth  wash  on  a  soft  brush,  during  the  intervals  between 
sittings  when  escharotic  and  antiseptic  agents  have  been  applied. 

CRETA  PR^PARATA— PREPARED  CHALK. 
PRECIPITATED    CHALK,    CARBONATE    OF    LIME. 

Formula. — CaCOg. 

Derivation. — Prepared  chalk  is  obtained  by  freeing  chalk  from 
such  impurities  as  gritty  and  flinty  substances  and  soluble  saline 
matter,  by  elutriation,  and  afterward  drying  it.  It  is  the  only 
form  in  which  chalk  is  used  medicinally. 

Medical  Properties  and  Action. — Prepared  chalk  is  antacid,  ab- 
sorbent and  astringent.  It  diminishes  the  secretion  of  the 
mucous  membrane,  and  at  the  same  time  acts  as  an  antacid  in 
correcting  any  acidity  present.  When  internally  administered 
for  a  considerable  time,  like  magnesia,  it  accumulates  in  the 
bowels  and  forms  intestinal  concretions;  hence  an  occasional 
aperient  is  necessary. 

Therapeutic  Uses. — Prepared  chalk  is  an  excellent  antacid  in 
diarrhoea  from  acidity,  in  acidity  attending  dyspepsia  and  gout, 
chronic  bronchitis  in  advanced  stages,  rachitis,  etc.  Externally, 
it  is  employed  in  the  treatment  of  ulcers,  burns,  excoriations  and 
skin  diseases.  It  moderately  stimulates  ulcers  and  absorbs  the 
discharge,  thus  preventing  them  from  spreading. 

It  is  an  antidote  for  poisoning  by  oxalic  and  most  of  the  vege- 
table and  mineral  acids. 

Dose. — Of  prepared  chalk,  gr.  v  to  3j,  in  powder  or  sus- 
pended in  water  by  the  aid  of  mucilage  and  sugar. 

Chalk  Mixture — Mistura  Creta — (prepared  chalk,  5ss ; 
acacia,  gr.  cxx;  water,  f.^iv)  is  often  combined  with  opiates  and 


PREPARED  CHALK. 


astringents,  such  as  laudanum  and  tincture  of  kino  or  of  catechu, 
in  the  treatment  of  diarrhoea.     Dose,  5j  to  oSS. 

Dental  Uses. — Prepared  chalk  is  used  in  dental  practice  chiefly 
for  its  antacid  property,  and  generally  as  an  ingredient  of  den- 
tifrices ;  it  is  also  employed  in  the  form  of  powder  as  an  antacid 
in  acidity  of  the  oral  fluids,  for  which  purpose  it  is  rubbed  be- 
tween the  teeth  and  permitted  to  remain  during  the  night ;  it  is 
also  employed  to  obtund  the  sensitiveness  of  dentine,  on  account 
of  its  absorbent  and  antacid  properties;  for  such  a  purpose  it 
should  be  applied  repeatedly,  for  several  days,  to  the  sensitive 
surface.  In  the  dental  laboratory  it  is  used  as  a  polishing  powder 
for  metal  and  plastic  work ;  also  for  polishing  the  surfaces  of 
gold  fillings.  The  precipitated  chalk  of  the  Pharmacopoeia  is 
the  preparation  to  be  preferred  on  account  of  its  freedom  from 
gritty  particles. 

DENTAL    FORMULA. 


Dentifrice  in  the  form  of  Troches. 


R 


Gretas  praeparatoe     . 

ib.iv 

Sodii  boratis  (pulv.) 

l^ 

Saponis  Castil    " 

l^ 

Sacch.  albse        " 

Ib.iss 

Ossis  sepise         " 

lb.iX 

Olei  rosas    .... 

gtt.xxx 

Millefleurs  .... 

I) 

Essentiae  jasmin 

1% 

R. 


Dentifrice. 
Am.  Dent.  Association. 


Mix  with  a  solution  of  gum  syrup. 


Cretae  praeparatae  . 
Pulv.  cinchonse  .  . 
Pulv.  radicis  iridis 
Pulv.  sacchari  albi 
Pulv.  saponis  cas.    . 

Sodi  carb 

Olei  sassafras  .    .    . 


Ibiij 
ftj 
ftj 
tbiss 

gtt.lxxx. 


Dentifrice  in  the  form  of  Camphorated 
Paste. 


R. 


Keller  Medicine  Co. 


Magnes.  carb.  . 
Glycerini  .  . 
Potas.  chlorat. 
Tr.  camphora 
01.  gaultherise 
Cretae  praep.    . 


Pts.  by  Wt. 

2 

I 

3 
I 

q.s. 
q.s. 


To  make  desired  number  of  parts. 

Syr.  simplic q.s,        M, 

To  make  a  thick  paste. 


Dentifrice. 

Am,  Dent.  Association. 

R.    Cretae  praep tbiij 

Pulv,  Cinchonas  .    .    .  Ibj 

Pulv.  radicis  iridis     ,  tbj 

Pulv,  sacchari  albi  Ibiss 

Pulv.  saponis  cas.       .  t^] 

Sodii  carb ^j 

Glycerini f  J  'U 

Mellis q.  s. 

And  form  into  a  paste. 


378 


DENTAL  MEDICINE. 


R. 


Dentifrice. 

Pu'lv.  radicis  iridis  . 

ftss 

Cretse  prseparatse  . 

^»v 

Sodii  carb 

3SS 

Pulv.  cinchonse  .    . 

3iv 

Pulv.  sacchari  albi  . 

5'J 

Pulv*.  rayrrhae     .    . 

3J 

Pulv.  ossis  sepiae    . 

^ij 

Otto  rosse        .    . 

glt.iv 

With  rose  pink,  q.  s.  to  color. 

Dentifrice   in   the  form  of  Glycerine 
Tablets. 

Keller  Medicine  Co. 


Pts 

.  by  Wt. 

R .    Solut,  magnes.  carb. 

2 

"      sodii  bicarb. 

I 

"      potas.  chlorat. 

3 

"      sapo.  cas.  albi 

6 

Glycerini     .... 

I 

Cal.  carb 

lO 

01.  gaultheria, 

Cassiae 

aa  q.  s.    M 

To  flavor. 

Dentifrice. 

U .    Cretse  praep.    .    .    . 

5»j 

Pulv.  radicis  iridis 

^ij 

Pulv.  sacchari  albi 

l\ 

Pulv.  cinnamon  .    . 

3"J 

Pulv.  saponis  cas.  . 

3U 

Pulv.  myrrhse      .    . 

3J 

01.  gaultheriae    .    . 

gtt.x.     M. 

Dentifrice. 

Dr.  a.  W.  Har 

LAN. 

R .    Cretae  prceparatae, 

Pulv.  radicis  iridis . 

aa  |ij 

Pulv.  saponis  cas., 

Pulv.  sodii  biboratis  . 

aa  3SS 

Pulv.  myrrhae     .    . 

30 

Mellis  et  glycerini 

q.s. 

To  make  a  soft  paste. 

Color  rose  pink.     Perfu 

me  to  suit. 

Dentifrice. 

Dr.  Chapin  a.  Harris. 

R .    Cretae  praeparatae    .    .     ^  iv 

Pulv.  rjidicis  iridis  .  .     J  iv 

Pulv.  cinnamon  ...     "z'w 

Sodii  carbonatis  exsic- 

catae ^ss 

Pulv.  sacchari  albi     .     ^j 
Olei  limonis    ....    gtt.xv 

Olei  rosae gtt-'j 

Signa. — Ingredients  to  be  thoroughly 
pulverized  and  well  mixed. 

Dentifrice. 

R.    Cretae  praeparatae   .    .  ftiss 
Pulv.  sodi  boratis, 
Pulv.  radicis  iridis  .    aa  tbrs 

Semen  cardamom      .  Jj 

Pulv.  sacchari  albi     .  Ibss 

Otto  rosae q.  s.       M. 

To  flavor. 

Dentifrice. 
Dr.  W.  D.  Miller. 
R .    Precipitated  carbonate 

of  calcium   ....  1^  iii|i^ 

Cinchona  bark   ...  ^xv 

Prepared  oyster  shell .  2[  xv 

Powd.  myrrh  ....  ^vii^ 

"       cloves  ....  ,^iij^ 

Oil  of  cinnamon  .  .    .  gtt.  x  to  xv. 
Mix  well. 

Dentifrice  in  the  form  of  a  Paste  for 
Compressible  lubes. 

Keller  Medicine  Co. 

Pt.-!.  by  Wt. 

R .  Magnes  carbonat.  .  .  2 
Sodii  bicarb.  .  .  .3 
Potas.  chlorat.  ...  5 
Calcii  carbonat.  .  .  20 
Sapo.  cas.  pulv.  ...     6 

Glycerini l 

Olei  gaultheriae, 

Olei  limonis    .    .    .  aa  q.  s. 

Syr.  simplic q.  s. 

Signa. — To  make  a  paste. 


PREPARED  CHALK. 


379 


For  Fetor  of  Breath. 
MlLLlRON. 
R.    Sulphur,  powd., 

Cretae  praep.  pulv.    .  aa  ^  j 
Spts.  rectificatus     .    .     gjss 

Aquae  distil ^  iij 

Peppermint     .    .    .    .     q.  s.       M. 
SiGNA. — After   removal   of   all    calcic 
deposits,     use    with    a    tooth-brush 
morning  and  evening. 

Dentifrice. 
Dr.  Darby. 
R .    Cretae  praeparatae    .    .     ^  viij 
Pulv.  radicis  iridis  ,  .     ^iv 
Pulv.  ossis  sepiae    . 
Pulv.  sacchari  albi  .  . 
Saponis  castil.  .   .    .  aa^j 

Sodae  bicarb ^  ss 

Pulv.  cinchonae  flava.      ^  j 

Cochineal gj 

Olei  rosae gtt.xx.  M. 

Rose  Dentifrice. 
R .    Cretae  praeparatae    .    .     ^  xv 
Pulv.  saponis  ....     ^  j 

Saccharin gr.x 

Thymolis gr.xv 

Camphorae gr.xxx 

Vanillin gr.v 

Olei  rosae gtt-vj.    M. 

Rub  the  camphor  and  thymol  to- 
gether in  a  mortar,  and  warm  gently  so 
as  to  render  the  mixture  liquid ;  then 
add  the  chalk  in  small  portions  at  a 
time,  reserving  about  one  ounce ;  next 
add  the  other  ingredients,  the  perfumes 
being  first  separately  rubbed  with  the 
remainder  of  the  chalk. 

Dentifrice,  Antacid,   Tonic  and  Anti- 
septic. 

R.  Cretae  praeparatae  .  .  ^iv 
Quininae  disulph.  .  .  gr.iv 
Pulv.  ossis  sepias  .  .  ^iv 
Otto  rosae gtt.iv.    M, 


Dentifrice. 
Dr.  a.  W.  Harlan. 

R .    Cretae  praeparatae    .    , 

Pulv.  radicis  iridis  .    aa  ^  iij 

Resorcin tj 

Saccharine gr.v 

Pulv.  ossis  sepiae    .    .     ^j 

Olei  menthae  piperitae.  y^\.      M. 

SiGNA. — Use   on   a    brush   moistened 
with  tepid  water. 


Dentifrice. 

Dr.  a.  W.  Harlan. 

R. 

Cretae  praeparatae    . 

,^»j 

Sodium  fluo.  silicate 

|ss 

Acidi  tannici      .    . 

gr.xxx 

Pulv.  sacchari  albi 

,^jss 

Pulv.  ossis  sepiae    . 

.^ss 

Olei  gaultheriae  .    . 

lU'^- 

M. 

To  make  a  paste  of  th 

e  above, 

add 

giy 

cerine  2  parts  and  hon 

;y  I  part. 

Cream  Dentifrice. 
Dental  Office  and  Laboratory. 
R.    Castile  soap,    in    fine 

powder ^  oz. 

Prepared  chalk  ...      i  oz. 
Oil  of  rose  geranium  .     8  drops. 
Glycerine  sufficient  to  determine  its 
consistence. 

Rose  Dentifrice. 
British  Journal  Dental  Science. 
R 


.    Precipitated  chalk  . 
Prepared  chalk  .    . 
Powdered  orris  .    . 

3^j 

Essence  of  vanilla  . 

3  "J 

Tincture  coumarin  . 
Tincture  benzoin   . 

3^j 
3"J 

Ammonia  (stronger) 
Carmine 

•    3J 
3J 

Oil  of  cloves   .    .    . 

nixij 

Glycerine    .... 
Or  a  sufficiency. 

I  iij- 

M. 


380  DENTAL  MEDICINE. 

Citroleine  Dentifrice. 
Dental  Office  and  Laboratory. 

IJ.        Precipitated  chalk Ibj 

Powdered  sugar ^ij 

Powdered  orris  root ^iv 

Cuttle-fish  bone ^  ij 

Bicarbonate  of  soda J  ij 

Oil  of  lemon ^  ij.      M. 

Dentifrices  may  be  pleasantly  flavored  with  wintergreen,  cassia, 
sassafras,  lemon,  peppermint,  anise,  lavender,  pennyroyal,  cloves, 
calamus,  attar  of  roses,  oil  of  neroli,  oil  of  rose  geranium,  etc. 
Cochineal  coloring  in  small  quantity  will  impart  a  pink  color  to  a 
dentifrice. 

CROTON— CHLORAL  HYDRAS. 
HYDRATE    OF    BUTYL    CHLORAL. 

Formula.— Q^f:.\O.Yi^O. 

Derivation. — Croton-chloral  Hydrate  is  obtained  by  the  action 
of  chlorine  gas  upon  aldehyde.  It  is  in  the  form  of  small,  bril- 
liant, white,  silvery  crystals  of  a  sweetish  taste,  like  that  of  mel- 
ons. It  is  slightly  soluble  in  water,  and  resembles  hydrate  of 
chloral  in  its  hypnotic  effects  ;  but  its  action  in  this  respect  is  not 
so  powerful,  nor  so  certain.  It  differs  from  hydrate  of  chloral  in 
the  singular  property  of  causing  anaesthesia  of  the  head.  To  re- 
lieve pain  and  induce  sleep,  the  best  effects  are  obtained  from  a 
combination  of  the  two  agents. 

Medical  Properties  and  Action. — It  is  a  sedative,  hypnotic  and 
anaesthetic.  It  resembles  chloral  hydrate,  but  is  not  so  certain  in 
its  effects  as  a  hypnotic.  Its  action  commences  in  the  head  and 
face. 

Therapeutic  Uses. — Croton-chloral  hydrate  is  highly  recom- 
mended in  dysmenorrhoea,  sciatica,  chronic  cough,  and  in  neu- 
ralgia as  an  anodyne.  One  or  two  grains  will  relieve  severe 
neuralgia  of  the  fifth  pair  of  nerves ;  it  is  frequently  necessary, 
however,  to  administer  from  five  to  fifteen  grains,  but  it  is  not 
safe  to  exceed  this  amount  at  one  time.  Croton  chloral  in  five 
or  ten  grain  doses,  in  pill  form,  administered  three  times  a  day, 


SULPHATE  OF  COPPER.  381 

often  relieves  facial  neuralgia.  The  dose  should  be  diminished 
after  two  or  three  days  to  five  grains  or  less  as  occasion  demands. 

Daze. — Of  croton-chloral  hydrate,  gr.  v  to  gr.  x ;  as  an 
anaesthetic,  gr.  xv,  dissolved  in  warm  water. 

Dental  Uses. — It  is  employed  with  effect  in  facial  neuralgia,  in 
doses  of  from  two  to  five  grains  every  hour  or  two,  until  fifteen 
grains  have  been  taken  ;  also  as  a  sedative,  in  doses  of  from 
three  to  five  grains,  in  periodontitis,  pulpitis,  etc.,  etc. 

DENTAL    FORMULA. 

For  Neuralgic  Odontalgia.  For  Neuralgia. 

Von  Kirchbauer. 

Dr.  Glassington. 

R .     Hydrate  of  butyl-chloral  gr.v 
Syrup  of  Tolu   .    .    .    .  tj 
Spirit  of  chloroform   .    .  X(\x 
Aquae gjss.  M. 

SiGNA. — Dose  to  be  repeated  in  one 
hour  if  relief  is  not  obtained. 

CUPRI  SULPHAS— SULPHATE  OF  COPPER. 
BLUE    VITROL,    BLUE    STONE. 
i^?m«/tf.— CUSO4+3H2O. 

Derivation. — Sulphate  of  copper  is  obtained  by  roasting  the 
native  sulphuret,  or  by  the  combination  of  oxide  of  copper  and 
sulphuric  acid,  filtering  and  crystallizing.  It  is  in  the  form  of 
blue  prismatic  crystals  which,  after  exposure  to  the  air,  effloresce 
to  a  slight  degree,  and  become  covered  with  a  greenish-white 
powder.     It  has  an  astringent,  metallic  taste. 

Medical  Properties  and  Action. — Sulphate  of  Copper  is  emetic, 
tonic,  nervine,  stimulant  and  astringent,  and  is  quite  soluble  in 
water,  but  insoluble  in  alcohol.  It  is  a  prompt  and  efficient 
emetic,  the  emesis  commencing  a  few  minutes  after  it  reaches 
the  stomach,  and  the  copper  comes  up  with  the  vomited  matter. 
Little  or  no  depression  follows  its  administration  as  an  emetic,  and 
it  is  especially  adapted  to  cases  of  narcotic  poisoning. 

Therapeutic  Uses. — Sulphate  of  Copper  is  employed  as  a 
prompt  and  efficient  emetic  in  cases  of  poisoning;  it  is  also  ad- 


R.     Croton  chloral     .    . 

■  3J 

Glycerini         ... 

•  3^J 

Aquffi  destill.  .    .    . 

•  5"ss 

Syr.  aurantii    .    .    . 

•  3'v 

Oleum  foeniculcE  .    . 

•  gtt.vj. 

M. 

SiGNA. — A  tablespoon ful, 

and  if 

pain 

continues  severe,  repeat 

the  dose  in 

an  hour. 

382 


DENTAL  MEDICINE. 


ministered  in  intermittent  fever,  neuralgia,  diarrhoea,  dysentery, 
croup,  epilepsy,  hysteria,  etc.,  etc.  Externally  it  is  applied  in 
ulcerative  and  gangrenous  affections,  superficial  hemorrhage, 
leucorrhoea,  gonorrhoea,  ringworm,  purulent  ophthalmia,  mucous 
discharges,  diseases  of  the  skin,  indolent  ulcers,  fungous  granula- 
tions, warts,  etc. 

Dose. — Of  sulphate  of  copper  as  an  emetic,  gr.  iij  to  gr.  v; 
or  dissolve  20  grains  in  two  ounces  of  distilled  water  and  give  a 
tablespoonful  every  15  minutes  until  vomiting  occurs.  For 
internal  use  other  than  emetic  the  dose  is  gr.  i  to  gr.  ss  in  pill. 

Dental  Uses. — Sulphate  of  copper  is  employed  in  dental  prac- 
tice, in  the  form  of  the  ammoniacal  solution,  for  long-standing 
cases  of  neuralgia ;  and  externally  it  is  applied  to  ulcers  of  the 
mouth,  cancrum  oris,  aphthous  ulceration,  ulceration  of  the  gums 
and  mucous  membrane  of  the  mouth,  hemorrhage  from  leech 
bites,  fungous  growths  of  the  gums,  etc.,  etc. 

Dr.  J.  G.  Templeton  recommends  powdered  sulphate  of 
copper,  for  suppurating  teeth,  applying  it  on  a  stick  of  wood 
which  is  wet  and  dipped  in  the  powder,  and  thus  can  be 
thoroughly  applied  to  the  diseased  parts ;  the  mouth  is  then  rinsed 
with  tinct.  of  gaultheria  or  tinct.  of  krameria. 


J^or  Cancrum   Oris,  Aphtha  and  Gan- 
grenous Affections  of  the  Mouth. 


B 


(pow- 


Cupri  sulph 

dered)      ,    .    .    .  gr.  v 

Mellis ^ss.  M. 

SiGNA. — Apply  as  a  lotion,  or  by  means 
of  a  camel's-hair  brush. 


DENTAL    FORMULA. 

For  Ulcerative  Stomatitis, 
B .     Cupri  sulph.    .        .  gr.  x 
Pulv.  cinchonse  .    .  jij 
Pulv.  gum  acacise   .  gij 

Mellis ^ij 

Aquse ^iij.  M. 

SiGNA. — Apply,  by  means  of  a  camel's- 
hair  brush,  to  the  ulcerated  surface. 


For  Gangrenous  Ulcers  of  the  Mouth 
and  Cancrum  Oris. 

R .  Cupri  sulph.  .  .  .  3  ij 
Pulv.  cinchonse  .  .  ^  ss 
Aquae ^iv.  M. 

SiGNA. — Brush  over  ulcerated  surface 
twice  daily. 


For  Caries  of  the  Maxillary  Bones. 
Bartholow. 
R.     Cupri  sulph., 

Zinci  chloridi  .    .    .  aa  partes  xv 

Liquor  plumbi    .    .        partes  xxx 

Aquae  destillatae  .    .        partes  cc. 

SiGNA. — To  be  applied  for  30  minutes 

at  a  time. 


DIGITALIS.  383 


DIGITALIS. 

Derivation. — Digitalis  is  obtained  from  the  leaves  of  the  Digi- 
talis purpurea^  or  Foxglove.  Digitoxin  and  Digitalin  are  the  tw^o 
most  active  principles,  but  neither  will  take  the  place  of  digitalis 
in  medicinal  use. 

Medical  Properties  and  Physiological  Action. — As  digitalis  irri- 
tates mucous  membranes  which  are  wanting  in  tone,  it  should 
not  be  internally  given  in  gastritis,  etc.  Its  action  is  only  mani- 
fested on  the  nerves  when  toxic  doses  are  administered.  Its 
action  is  chiefly  manifested  upon  the  circulatory  system,  as  it 
increases  the  pulse-force  and  arterial  pressure,  and  size  of  the 
pulse-wave,  and  slows  the  pulse,  when  moderate  doses  are  given. 
When  full  medicinal  doses  are  employed,  or  when  poisonous 
doses  are  injected,  the  action  of  the  heart  becomes  very  irregular, 
and  dicrotic,  and,  according  to  Hare,  it  is  not  due  to  weakness, 
for  the  cardiac  beats  when  they  occur,  are  in  themselves  more 
forcible  than  in  health.  Digitalis  only  effects  respiration  when 
poisonous  doses  are  given,  when  it  is  slowed. 

The  medicinal  dose  has  little  or  no  effect  upon  the  normal 
temperature  of  the  body ;  it  has  no  effect  on  the  kidney  struc- 
ture, but  sometimes  causes  nausea  and  indigestion  by  irritating 
the  stomach. 

Digitalis  is  a  cardiac  stimulant,  and  not  a  depressant. 

Therapeutic  Uses. — It  is  employed  in  all  cardiac  diseases,  and 
is  beneficial  when  the  heart  is  irritable  and  palpitation  is  present, 
and  the  cause  is  not  due  to  indigestion.  It  is  also  employed  in 
cardiac  weakness  from  collapse,  and  is  particularly  serviceable  in 
aconite  poisoning.  To  counteract  its  slow  action,  it  should  be 
preceded  by  ammonia  and  alcohol  in  urgent  cases.  It  is  also 
useful  as  a  diuretic  in  congested  kidney  affections,  and  in  cardiac 
dilatation  and  asthenia.  Tannic  acid  is  the  chemical  antidote ; 
also  the  stomach-pump,  and  emetics  if  the  heart  is  not  affected ; 
external  heat  about  abdomen,  and  the  maintainance  of  a  hori- 
zontal position  for  several  days  after  the  active  poisonous  symp- 
toms are  manifested.  Tincture  of  aconite  is  the  physiological 
antidote.  In  all  cases  it  is  necessary  that  the  slow  absorption 
and  elimination  of  digitalis  should  be  remembered.      Hypodermic 


384  DENTAL  MEDICINE. 


injections  of  the  tincture  TTlxv— xxx  are  valuable  in  sudden  heart 
depression  resulting  from  any  cause,  such  as  shock  or  collapse 
from  hemorrhage,  or  surgical  operations,  etc.,  etc.  Digitalis  must 
be  used  with  care  in  fatty  heart,  aneurism,  and  cerebral  endo- 
carditis. 

ELECTROZONE. 

Derivation. — Electrozone  consists  of  a  fluid  which  is  nothing 
but  sea  or  salt  water  subjected  to  an  electrolytic  current.  It  is 
a  clear  liquid,  neutral  in  reaction,  with  the  odor  of  free  chlorine, 
and  a  disagreeable,  salty  taste.  It  was  discovered  by  A.  E. 
Woolf,  who  has  succeeded  in  sterilizing  polluted  water  with  it 
on  a  large  scale. 

Properties  and  Dental  Uses. — Dr.  C.  F.  W.  Bodecker  recom- 
mends electrozone  as  an  efficient  antiseptic,  and  claims  that  it 
has  given  him  uniformly  satisfactory  results  in  the  treatment  of 
purulent  pulpitis.  His  method  is  to  open  the  pulp-chamber 
freely,  and  then  syringe  with  tepid  water.  The  electrozone  is 
then  introduced  into  the  pulp-chamber  on  a  small  piece  of  cotton 
saturated  with  it,  followed  by  one  or  two  smaller  pledgets  mois- 
tened with  the  electrozone.  The  patient  is  then  directed  to 
renew  only  the  last  piece  of  cotton,  from  three  to  five  times 
daily,  or  at  least  after  every  meal,  using  the  precaution  to  rinse 
the  mouth  with  a  weak  solution  of  electrozone  (about  a  teaspoon- 
ful  in  a  tumbler  of  water)  previous  to  the  removal  of  the  cotton. 

Every  pledget  of  cotton,  previous  to  its  introduction,  should 
be  moistened  with  pure  electrozone,  and  packed  as  tight  in  the 
cavity  of  the  tooth  as  possible.  When  the  tooth  has  been  treated 
in  this  manner  for  two  or  three  days,  the  pulp-canal  may  be 
cleaned  out  and  filled  at  once,  without  any  fear  of  future  perice- 
mentitis, provided  that  an  infection  of  pericementitis  has  not 
already  occurred. 

ENZYMOL. 

Derivation. — Enzymol  is  a  purified  solution  of  the  proteolytic 
enzyme  for  external  application,  and  is  obtained  by  a  direct  solu- 
tion from  the  stomach  glands  in  a  sterilized  menstruum,  being 


ERGOTA.— ERGOT.  385 


practically  an  artificial  gastric  juice,  active  and  acid  when  diluted 
with  water.     It  has  an  agreeable  odor  and  flavor. 

The  action  of  the  proteolytic  ferment  is  not  confined  to  purely 
alimentary  substances,  but  is  capable  of  dissolving  albuminous 
matter  in  the  various  forms  occurring  in  false  fibrinous  mem- 
brane, in  diseased  and  sloughing  tissues,  blood  coagula,  etc. 

Medical  Properties  and  Action. — Enzymol  is  a  physiological  sol- 
vent, antiseptic,  deodorizer  and  healing  agent.  It  is  effective  in 
all  situations  where  it  can  be  brought  and  held  in  contact  with 
septic  matter.  It  dissolves  by  digestion,  sloughs,  granulations  and 
detritus,  without  attacking  the  normal  parts.  It  converts  pus, 
necrosed  bone,  blood  coagula,  muco-pus,  etc.,  into  solution  by 
simple  hydration,  the  septic  matter  being  readily  discharged  or 
removed  by  irrigation.  It  also  destroys  offensive  odors,  and  pos- 
sesses healing  and  curative  effects.  For  general  use  it  should  be 
diluted  with  an  equal  volume  of  water.  In  treating  necrosed 
bone,  it  should  first  be  applied  undiluted,  in  order  to  quickly  and 
effectively  dissolve  the  calcareous  matter,  after  which  the  diluted 
form  is  applied.  In  cavities  it  may  be  applied  by  spray,  com- 
press, or  by  injection,  or  on  sterilized  cotton  or  wool  moistened 
with  it. 

Dental  Uses. — It  is  employed  in  alveolar  abscess,  alveolar 
pyorrhoea,  disease  of  the  antrum,  ulceration  of  the  gums,  frac- 
tured bones  of  the  jaws,  etc. 

ERGOTA— ERGOT. 

Derivation. — Ergot  is  derived  from  the  mycelium  of  the  fun- 
gous growth  which  replaces  the  grain  of  the  common  rye.  It  is 
bitter,  and  excites  heat  and  dryness,  followed  by  pain  in  stomach, 
thirst,  vomiting  and  intestinal  pain  and  sometimes  purging.  Small 
doses,  long  continued,  cause  spasms  and  death,  by  coma  and  as- 
phyxia; gangrene  of  the  lower  extremities  may  follow  its  pro- 
longed use. 

Medical  Properties  and  Physiological  Action. — Ergot  is  a  stimu- 
lant to  and  causes  contraction  of  the  involuntary  or  unstriped 
muscular  fibres  of  the  uterus,  and  smaller  blood  vessels.  It  is 
employed  to  produce  contraction  of  the  uterus  in  child-birth.  It 
25 


386  DENTAL  MEDICINE. 

is  also  administered  in  chronic  diarrhoea  and  dysentery,  enlarged 
heart  without  valvular  lesion,  gonorrhoea,  acne  rosacea,  etc.,  etc. 
It  is  very  serviceable  in  the  hemorrhagic  diathesis  where  there  is 
a  want  of  tonicity  of  the  vessels  ;  also  used  in  epistaxis,  uterine, 
renal  and  intestinal  hemorrhage,  and  in  hemoptysis,  bleeding  of 
hemorrhoids,  etc. 

Dose. — Of  the  fluid  extract  for  internal  use,  foss  to  5j ;  of  the 
wine  of  ergot,  5j  to  5ss ;  of  the  aqueous  extract  dissolved  in 
water  the  hypodermic  dose  is  gr.  y^  to  gr.  iij. 

Dental  Uses. — Ergot  in  the  form  of  the  fluid  extract — Extractum 
Ergotce  Fluidum — is  useful,  as  an  internal  remedy,  in  the  treat- 
ment of  hemorrhage  of  the  gums,  and  that  following  the  extrac- 
tion of  teeth  when  it  is  excessive  and  persistent. 

For  Alveolar  Hemorrhage. 
Dr.  Glassington. 

B .        Liquid  extract  of  ergot .^  i^s 

Dilute  sulphuric  acid gtt.40 

Water to  ^  iv- 

SiGNA. — Two  tablespoonfuls  every  half  hour  until  hemorrhage  ceases, 

ESSENTIAL  OILS. 

The  volatile  or  essential  oils  are  compounds  of  carbon  and 
hydrogen,  and  differ  from  the  fixed  oils,  which  are  compounds  of 
carbon,  hydrogen  and  oxygen,  the  molecular  arrangements  of 
which  are  similar  to  the  metallic  salts  and  compound  ethers — pos- 
sessing the  radicals  of  certain  acids  united  with  hydro-carbons. 
The  essential  oils  act  as  antiseptics  without  coagulation,  and  are 
generally  absorbers  of  oxygen,  and  such  of  them  as  the  oils  of 
peppermint,  cloves,  caraway,  cajeput,  mustard  and  turpentine  are 
useful  obtunders  of  hypersensitive  dentine  ;  and  some  are  also 
very  efficient  germicides  and  antiseptics.  The  oil  of  thyme  and 
oil  of  cinnamon  are  generally  considered  to  head  the  list  of  the 
essential  oils  in  antiseptic  power.  From  experiments  noticed  by 
Dr.  Harlan,  the  essential  oils  are  not  miscible  with  water;  hence 
when  they  are  used  as  a  root-dressing  they  are  not  contaminated 
or  dissipated  by  the  saliva  or  the  mixed  fluids  of  the  mouth. 
They   are  capable  of  depositing  vaporizable  camphors  that  are 


ESSENTIAL   OILS.  357 


powerful  disinfectants,  and  are  soluble  at  a  temperature  below 
body  heat.  They  are  good  menstrua  for  iodine  compounds,  and 
oily  dressings,  when  not  too  tightly  confined  in  a  pulp-chamber, 
are  not  vitiated  like  substances  which  are  soluble  in  water.  They 
may  be  allowed  to  remain  for  longer  periods  in  the  roots  of  teeth, 
when  it  is  not  possible  to  fill  such  roots  at  once.  When  an  oily 
•dressing  (such  as  oil  of  pepperment  or  oil  of  cassia)  is  applied  in 
a  root  canal,  after  the  removal  of  a  pulp  by  extirpation  or  its  de- 
vitalization by  arsenic,  it  acts  as  an  anodyne  and  also  as  an  anti- 
septic, preventing  the  formation  of  mephitic  gases.  The  oily 
dressings  may  be  pumped  through  roots  and  fistulous  tracts  with 
impunity,  and  will  not  clog  delicate  canals.  The  solutions  of  the 
essential  oils  are  all  made  as  follows  (Dr.  Black) :  "  An  excess  of 
the  oil  is  mixed  with  water  by  violent  shaking  continued  for  some 
minutes.  It  is  then  placed  in  the  incubating  oven,  where  the 
temperature  is  99°  F.,  for  twelve  hours.  It  is  then  again  vio- 
lently shaken  and  returned  to  the  oven  for  another  twelve  hours, 
twenty-four  hours  in  all.  It  is  then  carefully  filtered,  and  if  not 
perfectly  clear  and  free  from  all  appearance  of  oil,  it  is  refiltered 
until  it  is  clear.  The  filtrate  is  then  used  as  the  solution  of  the 
oil.  The  same  plan  is  used  in  making  saturated  solutions  of  the 
crystalline  substances." 

The  prominent  essential  oils  are  those  of  cajeput,  cassia,  cinna- 
mon, cloves,  eugenol,eucalyptol,  fennel,  mustard,  caraway,  pepper- 
mint, sassafras,  turpentine,  thyme,  pennyroyal,  valerian,  winter- 
green.  In  dental  practice  the  oil  of  cassia  diluted  with  a  bland 
oil  like  that  of  wintergreen  is  a  valuable  dressing  for  putrid  root 
canals  and  abscesses.  Dr.  Black  recommends  the  following  mix- 
ture : 

I^.  Carbolic  acid  (melted  crystals),  i  part ;  oil  of  cassia,  2 
parts;  oil  of  wintergreen,  3  parts.  Mix  the  oils  and  add  the 
melted  crystals  of  carbolic  acid.  This  is  known  as  the  i,  2,  3 
mixture. 

Dr.  Black  also  says  :  "  After  thorough  cleaning  with  the  watery 
form  of  the  antiseptic  we  need  something  that  will  be  more  en- 
during in  its  effects,  and  according  to  conditions,  should  choose 
between  the  oils  and  the  powders.     If  it  is  an  abscess  with  which 


388  DENTAL  MEDICINE. 


we  have  to  deal,  an  oil  which  is  in  itself  an  antiseptic,  or  an  oil 
holding  the  antiseptic  drug  in  solution  in  effective  proportions^ 
may  be  introduced  into  the  cavity  and  so  agitated  as  best  to  bring 
it  in  contact  with  all  of  its  parts.  This  will,  on  account  of  its 
sparing  solubility,  remain  in  position  very  much  longer  than  the 
watery  forms,  and  the  essential  oils  are  very  much  more  diffusible 
than  the  fixed  oils,  or,  indeed,  any  other  of  the  simple  forms  of 
the  antiseptics  with  which  I  am  yet  acquainted.  At  the  same 
time  a  sufficient  amount  for  very  extended  work  is  contained  in 
small  compass.  These  are  of  especial  value  in  such  positions  as 
the  roots  of  teeth.  In  this  position  any  but  the  most  irritating  of 
the  antiseptic  essential  oils  may  be  used  to  good  advantage,  and 
may  be  relied  upon  for  many  days  together.  In  the  choice  of  the 
essential  oils  it  is  by  no  means  necessary  that  the  most  powerful 
of  them  be  selected.  It  should  be  remembered  in  making  the 
choice  that  the  more  powerful  antiseptics  are  the  more  irritating 
as  a  rule.  It  is,  therefore,  often  best  to  choose  antiseptics  of  very 
moderate  range,  especially  where  it  is  only  required  to  preserve  a 
condition  of  asepsis.  For  instance,  when  a  very  foul  root  canal 
is  opened,  such  an  antiseptic  as  the  oil  of  cassia  is  indicated. 
After  appropriate  cleaning,  and  especially  in  case  cleaning  is  to 
be  deferred  for  fear  of  forcing  poisonous  material  through  the 
apical  foramen,  it  may  be  used  in  full  strength  ;  in  which  form  it 
may  be  relied  upon  as  a  disinfectant  as  well.  But  afterward^ 
when  it  is  only  a  matter  of  holding  an  aseptic  condition  during 
the  healing  of  the  parts,  an  antiseptic  of  shorter  range,  that  is  not 
so  liable  to  injure  the  tissues,  is  to  be  preferred.  For  this  purpose 
the  eucalypti  extract  in  substance  is  a  very  useful  agent.  Its 
range  of  actual  inhibition  is  very  short,  but  its  injurious  effects  on 
the  tissues  are  also  very  slight,  so  that  the  healing  process  may  go 
on  in  its  presence  without  hindrance.  Furthermore,  this  oil  has 
a  very  extended  range  of  restraining  influence  beyond  its  range  of 
actual  inhibition  that  is  undoubtedly  of  much  use.  This  oil  may 
be  exchanged  for  terpinol  where  a  little  more  stimulating  effect  is 
regarded  as  beneficial.  The  oil  of  cloves  and  the  oil  of  cinnamon 
seem  to  occupy  a  middle  ground,  and  may  be  made  useful  in  a 
large  class  of  cases  if  the  others  are  in  any  wise  distasteful  to  the 


DICHLORIDE  OF  ETHIDEXE.  389 

dentist  or  his  patient.  The  oil  of  mustard,  though  a  good  anti- 
septic of  short  range,  has  an  irritant  action  that  limits  its  use. 
Yet  in  cases  where  it  is  desirable  to  arouse  the  tissues  from  a  state 
of  inactivity  this  action,  in  a  high  degree,  is  combined  with  the 
antiseptic  property.  It  is  also  one  of  the  most  diffusible  of  the 
antiseptic  oils  thus  far  studied. 

"  Any  of  these  oils  may  be  used  in  the  emulsion,  if,  for  any 
reason,  it  is  not  thought  well  to  use  the  oil  in  substance.  This 
form  is  especially  recommended  for  surfaces  of  suppurating 
wounds  and  the  washing  of  abscesses.  In  this  way  small  quanti- 
ties of  the  oil  may  be  widely  diffused  and  left  in  a  multitude  of 
minute  globules,  to  gradually  dissolve  where  it  is  most  wanted, 
forming  a  kind  of  connecting  link  between  the  true  solutions 
and  the  oils  in  substance.  For  this  purpose  a  little  of  the  oil 
selected  may  be  diffused  through  water  by  severe  shaking,  or  bet- 
ter, by  repeatedly  filling  and  violently  emptying  the  syringe. 
The  milky  emulsion  thus  formed  may  be  used  in  the  same  man- 
ner as  the  solution. 

"  I  have  said  that  all  antiseptics  are  poisons.  I  wish  to  em- 
phasize this  statement.  They  are  antiseptic  by  virtue  of  their 
power  of  restraining  life  forces ;  and  their  use  as  antiseptics  is 
permitted  only  by  shades  of  difference  in  the  action  of  certain 
poisons  toward  the  different  forms  of  life,  by  which  they  affect 
the  fungi  more  prominently  than  the  animal  tissues." 

ETHIDENE  DICHLORIDUM— DICHLORIDE  OF  ETHIDENE. 

Formula. — CH3CHCI2.     Sp.  gr.  1,225. 

Derivation. — Dichloride  of  Ethidene  is  obtained  in  the  prep- 
aration of  chloral,  from  the  waste  products,  and  is  very  much 
like  chloroform  in  appearance,  odor  and  taste.  It  has  a  variable 
boiling  point  of  about  115°  F.,  and  is  readily  soluble  in  alcohol, 
sparingly  soluble  in  water,  and  but  slightly  soluble  in  chloroform. 
It  is  inflammable,  but  less  so  than  alcohol. 

Medical  Properties  and  Action. — Dichloride  of  ethidene  is  a 
general  anesthetic,  and  is  said  to  occupy  an  intermediate  rank 
between   chloroform   and   ether.     It   reduces  the   action   of  the 


390  DENTAL  MEDICINE. 


heart  to  a  less  degree  than  chloroform,  with,  however,  consider- 
able depression  of  the  pulse. 

It  has  been  somewhat  employed  in  England,  where  it  is  re- 
garded as  being  safer  than  chloroform  for  inhalation,  and  requir- 
ing less  quantity  to  produce  anaesthesia  than  ether. 

Methods  of  Administration. — It  is  recommended  to  administer 
nitrous  oxide  until  the  patient  is  nearly  unconscious,  and  then  to 
add  the  vapor  of  ethidene.  The  effects  of  this  agent  are  de- 
scribed as  follows :  The  pupils  dilate,  and  at  the  same  time 
stertorous  breathing  commences;  the  pulse  falls,  and  should  be 
carefully  watched,  and  insensibility  to  pain  continues  for  some 
time  after  the  patient  becomes  conscious.  It  is  also  claimed  for 
this  agent  that  there  are  no  unpleasant  after-effects,  the  patient 
recovering  as  if  from  a  natural  sleep,  with  a  clear  mind  and  a 
distinct  utterance.  It  is  also  recommended  to  combine  the  vapor 
of  ethidene  with  that  of  nitrous  oxide,  by  loosely  inserting  a 
sponge  containing  half  an  ounce  of  ethidene  in  the  nitrous  oxide 
gas-inhaling  tube,  or  in  the  rubber  supply-bag,  when  the  effect  is 
said  to  be  more  profound  and  agreeable  than  when  nitrous  oxide 
alone  is  administered,  with  no  nausea  and  but  little  lividity  of  the 
lips.  It  is  also  said  to  produce  relaxation  of  the  muscles  rather 
than  rigidity,  differing  in  this  respect  from  nitrous  oxide  gas. 

Dichloride  of  ethidene  is  also  employed  as  a  local  anaesthetic, 
in  the  same  manner  as  chloroform,  aconite,  etc.,  for  the  relief  of 
facial  neuralgia,  etc. 

It  has  not  been  introduced  to  any  extent  into  this  country. 

ETHYL   CHLORIDUM— (MONO-CHLOR-ETHANE). 
CHLORIDE    OF    ETHYL. 

Formula.— Q^  fix. 

Derivation. — Ethyl  chloride  is  best  prepared  by  saturating  an 
artificially  cooled  alcoholic  solution  of  zinc  chloride  with  hydro- 
chloric acid  gas ;  it  may  also  be  obtained  as  a  by-product  in  the 
manufacture  of  chloral.  It  belongs  to  the  ether  class,  and  at 
ordinary  temperature  is  a  gas  ;  but  it  is  easily  compressed,  and 
then  forms  a  colorless  liquid  possessing  an  agreeable,  but  not 
very  strong  ethereal  odor,  boiling  between  50°  and  53.6°  F.,  and 


ETHYL  CHLORIDUM.  391 


burning  with  a  green  flame.  It  is  sold  in  the  compressed  state  in 
hermetically  sealed  glass  tubes,  elongated  to  a  capillary  point, 
which  serves  not  merely  as  a  vehicle  for  containing  it,  but  also  as 
the  apparatus  for  applying  it,  for  owing  to  its  low  boiling  point  it 
is  admirably  adapted  in  this  form  to  the  rapid  production  of  anaes- 
thesia. The  best  manner  suggested  for  breaking  the  flask  or 
tube  is  to  hold  it  vertically,  attenuated  end  up  ;  grasp  the  pointed 
end  with  a  pair  of  plyers  and  fracture  at  the  file  mark  which  is 
made  nearer  or  at  the  end  of  the  capillary  elongation,  so  that  the 
escaping  stream  of  vapor  shall  be  attenuated  to  the  greatest  de- 
gree possible,  and  then  directed  upon  the  surface  to  be  anaesthet- 
ized.    It  is  inflammable. 

Mode  of  Application. — The  distance  at  which  the  glass  tube 
should  be  held  from  the  part  to  be  anaesthetized  varies  consider- 
ably, for  it  may  be  two,  six,  eight,  ten,  or  even  twenty  inches, 
depending  somewhat  upon  the  size  of  the  aperture  in  the  elon- 
gated end  of  the  tube  ;  it  is  necessary  that  the  stream  of  vapor 
should  reach  the  tissue  exactly  at  the  time  of  perfect  volatiliza- 
tion. After  the  attenuated  end  of  the  tube  is  broken  ofF  at  the 
file  mark  the  tube  is  then  everted,  and  the  heat  of  the  hand 
grasping  it  will  accelerate  the  escape  of  the  stream  of  vapor, 
which  may  be  arrested  by  returning  the  tube  to  the  position  in 
which  it  was  held  when  broken,  and  placing  a  finger  over  the 
aperture.  Each  flask  or  tube  contains  ten  grammes  of  pure 
chloride  of  ethyl,  which  is  considered  to  be  sufficient  for  the  ex- 
traction of  about  four  teeth.  When  only  a  portion  of  the  con- 
tents of  the  tube  has  been  used,  the  remainder  can  be  preserved 
by  forcing  the  broken  end  into  a  rubber  stopper  and  setting  it  in 
a  cool  place  ;  or  a  little  adhesive  wax  may  be  forced  into  the 
aperture,  but  not  melted  and  dropped  on. 

Therapeutic  Uses  and  Action. — Chloride  of  ethyl  is  employed 
in  minor  and  dental  surgery  as  a  local  anaesthetic,  and  its  appli- 
cation does  not  occasion  any  untoward  accessory  symptoms,  and 
it  has  no  influence  on  the  brain,  having  in  this  respect  a  great 
advantage  over  methyl  chloride  whose  application  is  followed  by 
a  weakness  of  memory  usually  lasting  for  more  than  twelve 
hours;  ethyl   chloride  does  not   produce  the  extraordinary  cold 


392  DENTAL  MEDICINE. 


which  may  cause  destruction  of  tissue  as  does  methyl  chloride. 
Chloride  of  ethyl  will  produce  general  anaesthesia  if  inhaled,  and 
it  is  therefore  necessary  when  applying  it  within  the  mouth  to 
have  the  patient  breathe  only  through  the  nose,  as  there  is  no 
evidence  of  its  safety  as  a  general  anaesthetic.  Properly  applied, 
and  not  too  long  continued,  there  is  no  danger  of  freezing  the 
part  to  the  stage  of  devitalization  with  consequent  sloughing. 
On  account  of  its  great  inflammability  it  must  be  used  at  a  safe 
distance  from  a  flame — preferably  under  electric  light  when 
applying  it  at  night.  As  it  is  extremely  volatile  it  should  be  kept 
in  a  cool  place ;  and  this  extreme  volatility  is  a  proof  that  its 
effect  upon  the  human  system  is  of  correspondingly  brief  du- 
ration, as  it  acts  not  by  virtue  of  any  inherent  anaesthetic  proper- 
ties, but  on  account  of  the  intense  cold  produced  by  its  extra- 
ordinary rapid  volatilization.  Its  depressing  effect  upon  the 
circulation  when  administered  is  too  pronounced  for  it  to  be 
regarded  as  a  safe  general  anaesthetic.  As  a  local  anaesthetic, 
however,  it  has  practically  no  effect  upon  the  human  system,  and 
any  of  the  drug  that  is  absorbed  into  the  system  is  eliminated  in 
the  course  of  a  few  minutes.  It  has  given  satisfactory  anaesthesia 
in  operations  for  cellulitis  of  fingers,  buboes,  abscesses,  sinuses, 
boils,  carbuncles,  in-growing  nails,  etc.,  all  forms  of  neuralgic 
pain,  rheumatic  pain,  hyperaesthenic  and  reflex  conditions. 

Dental  Uses. — Chloride  of  ethyl  is  employed  in  dental  practice 
as  a  local  anaesthetic  for  the  extraction  of  teeth,  and  has  proven 
very  satisfactory  in  such  operations.  The  adjoining  teeth  should 
be  protected  by  a  fold  of  napkin,  the  gum  dried  about  the  tooth 
to  be  extracted,  and  then  coated  with  glycerine,  and  the  vapor 
directed  on  the  gum  and  not  upon  the  tooth  until  the  former 
turns  white,  when  the  forceps  are  applied.  It  is  also  used  for 
obtunding  the  pulp  prior  to  extirpating  it,  and  also  for  obtunding 
sensitive  dentine,  for  which  purposes  the  rubber  dam  should  be 
adjusted  large  enough  to  cover  the  nose,  and  the  cavity  dried,  as 
the  drug  has  little  or  no  affinity  for  water,  and  the  vapor 
thoroughly  introduced  to  the  sensitive  surface  of  the  dentine  or 
to  the  exposed  surface  of  the  pulp,  when  the  excavation  or 
removal  can  be  painlessly  performed.     Dr.  L.  E.  Custer  recom- 


BROMIDE  OF  ETHYL.  393 


mends  grinding  ofF  the  point  of  the  tube  with  a  corundum  or 
carborundum  disk  about  one-fourth  of  an  inch  further  toward 
the  end,  in  order  that  the  jet  of  vapor  may  be  so  attenuated  by 
escaping  from  a  smaller  orifice  that  it  will  not  flood  the  cavity 
before  it  volatilizes  fast  enough.  Chloride  of  ethyl  is  also 
employed  for  the  relief  of  neuralgia  by  directing  the  vapor  along 
the  track  of  the  affected  nerve ;  also  for  diagnosing  peripheral 
from  centric  neuralgias  by  applying  the  vapor  at  the  point  of 
irritation — if  the  neuralgia  results  from  peripheral  irritation  the 
pain  will  cease  at  once ;  and  intermittent  applications,  continued 
for  from  twenty  to  thirty  minutes,  are  often  curative  when  the 
irritation  is  not  due  to  exposure  of  the  pulp.  Chloride  of  ethyl 
may  also  be  employed  for  opening  alveolar  abscesses,  removing 
tumors  of  the  mouth,  and  in  other  painful  affections  of  the  oral 
cavity.  Prof.  C.  Redard  suggests  that  in  the  extraction  of  teeth 
in  the  lower  jaw  the  vapor  or  stream  be  directed  externally 
against  the  cheek,  over  the  inferior  maxillary  nerve;  while  in 
the  extraction  of  teeth  from  the  upper  jaw  it  be  directed  in  front 
of  the  ear  at  the  exit  of  the  trigerminal  nerve.  When  applied  to 
a  part  chloride  of  ethyl  first  causes  a  hyperemia,  then  pallor,  and 
gradually  the  part  assumes  a  parchment-like  appearance.  From 
one  to  two  minutes  is  gradually  required,  and  the  anaesthesia 
lasts  as  long  again.  It  has  been  suggested  to  occasionally 
combine  the  action  of  chloride  of  ethyl  with  that  of  cocaine. 

Jnestile  is  a  mixture  of  ethyl  and  methyl  chloride  and  acts  in 
the  same  manner  as  chloride  of  ethyl.     (See  Coryl.^ 

ETHYL  BROMIDUM— BROMIDE  OF  ETHYL. 
HYDROBROMIC    ETHER. 

Formula. — CgHjBr.     Sp.  gr.  1.420. 

Derivation. — Bromide  of  Ethyl  is  obtained  from  bromide  of 
potassium,  sulphuric  acid,  alcohol  and  water,  by  distillation,  and 
is  re-distilled  by  chloride  of  calcium.  It  is  a  colorless  and  very 
volatile  liquid,  boiling  at  40°  C,  heavier  than  water,  and  pos- 
sesses an  agreeable  ethereal  odor,  and  a  pungent  taste,  strong  and 
sweetish,  with  a  somewhat  burning  after-taste.  It  is  readily 
soluble  in  alcohol  arid  ether,  and  but  sparingly  soluble  in  water. 


394  DENTAL  MEDICINE. 


Medical  Properties  and  Action. — Bromide  of  ethyl,  like  all  other 
agents  of  this  class,  must  be  administered  with  great  care,  and  a 
pure  article  employed.  There  is  no  doubt  but  that  it  is  pleas- 
anter  to  inhale  than  chloroform,  exceedingly  rapid  in  producing; 
complete  unconsciousness,  and  very  evanescent  in  its  action  ; 
but,  from  the  fatalities  attending  its  use,  it  is  a  dangerous  agen'. 
Like  chloroform  ethyl  bromide  destroys  life  by  its  effect  upon  the 
heart ;  on  account  of  its  being  essentially  poisonous  owning  to  the 
large  percentage  of  bromine  which  it  contains;  and  its  poisonous 
effect  when  not  at  once  fatal  is  prolonged  and  dangerous  to  the 
heart,  and  other  vital  organs,  especially  the  kidneys.  Its 
poisonous  effects  are  more  pronounced  when  it  is  administered  in 
an  upright  or  even  half  reclining  position  as  for  dental  operations. 

Introduced  into  the  stomach,  bromide  of  ethyl  does  not  pro- 
duce anaesthesia,  as  when  absorbed  by  the  respiratory  organs,  and 
does  not  increase  the  pulse  over  its  normal  beat ;  and  in  the 
second  stage,  causes  an  intermission  of  the  pulse  every  second  beat. 

Administration.  —  Bromide  of  ethyl  when  employed  as  an 
anaesthetic  is  best  administered  in  a  folded  starched  napkin,  so  as 
to  cover  the  face,  and  having  inside  of  it  a  soft  linen  handker- 
chief. On  the  linen  handkerchief  one  measured  drachm  of  the 
agent  should  be  poured,  and  the  patient  directed  to  take  long, 
deep  inspirations,  or,  what  is  better,  to  make  prolonged  and 
forced  expirations.  In  two  minutes  from  the  time  of  adminis- 
tration of  the  first  drachm,  a  second  should  be  given,  and  this 
should  be  repeated  at  intervals  of  two  minutes.  Like  all  general 
anaesthetics,  however,  the  quantity  for  inhalation  differs  accord- 
ing to  the  susceptibility  of  the  patient.  One  drachm  (or  in 
some  cases  two  drachms  may  be  required,  according  to  the 
susceptibility  of  the  patient)  of  the  bromide  of  ethyl  will  gener- 
ally, in  from  one  to  three  minujes,  produce  an  anaesthesia  as  pro- 
found as  that  produced  by  an  ounce  of  sulphuric  ether.  As  it 
produces  an  anaesthetic  effect  on  the  muscles  of  the  throat  and 
upper  parts  of  the  pharynx,  it  is  useful  for  operations  on  the 
mouth  and  throat. 

The  effect  of  an  anaesthetic,  however,  is  to  be  more  regarded 
than  the  mere  quantity  of  the  agent  poured  upon  a  napkin  or 


BROMIDE  OF  ETHYL.  395 

sponge,  as  the  degree  of  anaesthesia  should  be  governed,  in  most 
cases,  by  the  nature  of  the  operation  to  be  performed  under  its 
influence. 

The  odor  of  bromide  of  ethyl  is  more  rapidly  removed,  and  is 
more  agreeable  than  that  of  sulphuric  ether,  and  its  effects  more 
rapid  than  even  those  of  chloroform,  as  it  is  eliminated  by  respira- 
tion, and  by  the  kidneys.  Having  no  caustic  action,  it  can  be  safely 
applied  subcutaneously,  and  also  to  the  external  auditory  meatus 
and  to  the  mucous  membrane.  It  evaporates  upon  the  skin  very 
rapidly,  producing  a  very  sensible  feeling  of  cold.  The  general 
effects  claimed  for  ethyl  bromide  are  as  follows  :  Moderate  ac- 
celeration of  the  pulse  and  respiration  ;  slight  excitement  or  talk- 
ing, and  seldom  any  struggling  ;  flushing  of  face  ;  dilatation,  some- 
times preceded  by  contraction  of  pupil ;  diaphoresis,  generally 
profuse ;  complete  anaesthesia  in  two  or  three  minutes ;  recovery 
of  consciousness  in  from  one  to  two  minutes  after  the  withdrawal 
of  the  anaesthetic  agent ;  no  after-vomiting. 

Any  specimen  of  bromide  of  ethyl  which  has  a  disagreeable 
odor,  or  which,  on  standing,  becomes  brown,  or  any  that  will 
explode  and  burn,  is  impure  and  should  not  be  employed  for  in- 
halation. A  common  impurity  is  hromoform^  produced  by  the 
action  of  bromine  and  caustic  potassa  on  alcohol  or  wood  spirit. 
Bromide  of  ethyl  possesses  properties  intermediate  between  those 
of  chloroform  and  ether.  As  a  local  anaesthetic  it  is  highly 
spoken  of,  and,  owing  to  its  non-inflammability,  is  the  only 
anaesthetic  which  can  be  used  in  connection  with  the  actual 
cautery.  Dr.  Byrd  strongly  recommends  an  anaesthetic  mixture 
of  bromide  of  ethyl  i  part,  chloroform  3  parts  and  alcohcl  4 
parts,  a  drachm  of  which  is  poured  upon  the  sponge  of  the  in- 
haler, which  the  patient  is  allowed  to  inhale  with  the  stopper  out, 
after  which  the  stopper  is  replaced  and  the  full  strength  of  the 
mixture  inhaled.  Generally  in  five  minutes  the  patient  is  fully 
anaesthetized,  when  the  stopper  may  be  taken  out  to  permit  a 
greater  admixture  of  air,  and  replaced  as  the  judgment  of  the 
operator  may  dictate.  This  mixture,  it  is  claimed,  is  safer  and 
less  disagreeable  in  its  effects  than  the  bromide  alone.  For  use 
as   a   local  anaesthetic,  the  bromide  of  ethyl  is  atomized  with  the 


396  DENTAL  MEDICINE. 


"  spray  apparatus,"  which  should  furnish  enough  of  the  liquid  to 
moisten  the  skin.  The  extremity  of  the  tube  should  be  held 
some  two  or  three  inches  from  the  surface  on  which  the  spray  is 
to  be  thrown.  Within  two  or  three  minutes  after  its  first  appli- 
cation, anaesthesia  of  the  part  occurs,  which  is  shown  by  the  ap- 
pearance of  a  white  spot.  The  formation  of  this  spot  may  be 
hastened  by  superficially  puncturing  or  scratching  the  skin.  The 
sensation  of  cold  thus  produced  is  sometimes  disagreeable,  but 
is  rarely  painful. 

Given  internally  it  is  also  said  to  relieve  gastric  pain  without 
affecting  the  appetite.  Inhalations  have  been  used  to  relieve 
convulsive  cough ;  and,  introduced  on  cotton  wool  into  the  ex- 
ternal meatus,  it  is  said  to  relieve  the  pain  of  otalgia,  without 
causing  any  irritation. 

EUCAINE. 

Formula.— C^gH^NOiHCiH^O. 

Derivation. — Eucaine  is  an  artificial  alkaloid  produced  by  the 
reaction  between  acetone  (dimethyl  ketone,  CH3COCH3),  and 
ammonia.  Two  chemical  substances  having  the  name  of  Eucaine 
have  been  introduced,  each  of  them  depending  for  its  anaesthetic 
property  upon  the  presence  of  the  benzoyl  molecule  in  its  con- 
stitution. They  are  called,  AIpha-Eucaine  and  Beta-Eucaine. 
Although  Alpha-Eucaine  was  the  substance  usually  sold  under 
the  name  of  Eucaine,  yet  it  is  as  poisonous  as  cocaine,  while 
Beta-Cocaine  is  not,  cocaine  being  three  times  more  toxic.  The 
use  of  Alpha-Cocaine  has  been  almost  entirely  discontinued. 
The  salt  principally  employed  is  the  hydrochlorate  which,  when 
evaporated  from  the  aqueous  solution,  retains  one  molecule  of 
water  of  crystallization. 

Hydrochlorate  of  eucaine  is  in  the  form  of  a  white,  odorless 
crystalline  substance,  or  powder  of  a  bitter  taste  like  that  of 
quinine,  and  soluble  in  water,  chloroform  and  alcohol. 

Medical  Properties  and  Action. — Eucaine,  when  applied  locally', 
induces  some  hyperemia  of  the  mucosae,  rather  than  anemia,  but, 
nevertheless,  causes  a  very  decided  loss  of  sensibility.  It  has  a 
marked  advantage  over  cocaine  in  being  less  poisonous,  although 


EUCAINE.  397 

their  dosages  are  very  similar.  Lethal  doses  cause  excitation  of 
the  central  nervous  system,  convulsions  affecting  all  the  muscles, 
general  paralysis,  and  death  by  a  failure  of  the  respiration.  There 
is  no  ischemia  due  to  contraction  of  the  blood  vessels,  as  in  co- 
caine anaesthesia,  and  no  paralysis  of  accommodation.  According 
to  Prof.  Hare,  however,  eucaine  is  capable  of  producing  internal 
effects  resembling  an  over-dose  of  cocaine,  which  must  be  treated 
bv  the  use  of  strong  coffee,  alcohol,  digitalis  and  strychnine.  If 
the  case  is  pressing,  ether,  ammonia  and  nltro-glycerine  may  be 
used  as  rapidly  acting  stimulants.  Solutions  of  eucaine  hydro- 
chlorate  (one  part  to  ten  parts  of  sterilized  water)  remain  per- 
manently unchanged,  and  boiling  will  not  produce  decomposition, 
which  is  another  advantage  over  solutions  of  cocaine  hydro- 
chlorate.  This  immunity  is  supposed  to  be  due  to  its  immediate 
derivation  from  pure  chemicals,  instead  of  from  vegetable  sources. 
The  local  effect  of  eucaine  hydrochlorate  upon  the  circulation  is 
the  production  of  hyperemia,  whereas  that  of  cocaine  is  ischemia. 
Eucaine  also  exalts  the  nervous  system,  when  paralysis  follows, 
the  effect  being  central,  causing  acceleration  of  the  heart-beats 
through  sedation  of  the  pneumogastric  nerve.  Experiments 
made  by  Dr.  A.  H.  Peck  lead  him  to  conclude  that  the  action  of 
cocaine  is  inconstant,  while  those  of  eucaine  are  constant ;  that 
the  first  action  on  the  heart  and  respiration  of  eucaine  is  that  of 
a  stimulant,  the  after-effects  being  that  of  a  decided  depressant ; 
that  eucaine  causes  death  in  animals  by  paralyzing  the  muscles 
of  the  heart  and  of  the  respiratory  apparatus,  they  ceasing  to 
operate  simultaneously,  while  cocaine  causes  death  by  paralyzing 
the  muscles  of  the  respiratory  apparatus,  the  heart's  action  con- 
tinuing in  a  feeble  way  for  a  brief  period  after  breathing  ceases; 
that  eucaine  in  toxic  doses  nearly  always  causes  nausea,  and  oc- 
casionally vomiting,  while  cocaine  is  much  less  nauseating  and 
scarcely  ever  causes  vomiting;  that  cocaine  is  at  least  three  times 
more  toxic  than  Beta-Eucaine,  and  that  Alpha-Eucaine  is  as  toxic 
as  cocaine.  Eucaine  solutions  should  be  prepared  with  distilled 
or  sterilized  water,  and  then  brought  to  the  boiling  point.  All 
solutions  should  be  freshly  prepared  to  obtain  the  positive  results. 
Dental  Uses. — Beta-eucaine  is  employed  in  dental  practice  as  a 


398  DENTAL  MEDICINE. 


local  anaesthetic.  A  ten  per  cent,  solution  may  be  made  by  add- 
ing 48  grains  of  beta-eucaine  to  the  ounce  of  distilled  water,  and 
the  solution  brought  to  the  boiling  point.  Of  such  a  solution 
(10  per  cent.)  five  to  eight  minims  is  a  proper  dose  by  hypodermic 
injection.  Some  recommend  an  eight  per  cent,  solution  as  strong 
enough  for  the  painless  extraction  of  teeth.  The  mode  of  ap- 
plication and  the  precautions  to  be  observed  in  employing  such  a 
solution  in  the  extraction  of  teeth,  are  similar  to  those  for  the 
administration  of  cocaine  solutions. 

Eucaine  solution  is  also  serviceable  in  capping  crowns  of  teeth, 
inserting  bridge-work,  and  applying  clamps  in  connection  with 
the  rubber  dam,  especially  when  the  gums  are  tender  and  bleed- 
ing ;  also  for  hypersensitive  dentine,  especially  by  the  cataphoric 
method.     (See  Vapocaine.) 

EUCALYPTUS. 

Source. — Eucalyptus  is  obtained  from  the  eucalyptus  globulus, 
a  tree  of  large  size,  and  of  the  natural  order  Myrtaceae,  found 
originally  in  Australia,  and  known  as  the  "  Blue  Gum  Tree." 
These  trees  are  now  growing  in  the  southern  parts  of  Europe 
and  the  United  States,  and  northern  Africa,  and  their  presence  is 
thought  to  be  preventive  of  malaria.  The  leaves,  which  arc 
ensiform,  of  a  grayish-green  color,  and  parchment-like,  are  the 
only  part  which  possesses  medicinal  qualities.  They  have  a 
pleasant,  aromatic  odor,  with  a  warm,  bitter,  and  somewhat 
pungent  taste,  like  that  of  cubebs,  the  fresh  being  more  active 
than  the  dried  leaves. 

The  chief  medicinal  constituent  of  eucalyptus  is  the  oil 
{Oleum  Eucalypti  U.  S.),  from  which  is  derived  a  camphoraceous 
body  obtained  by  re-distillation  with  caustic  potash  or  chloride  of 
lime,  known  as  Eucalyptol^  U.  S.  The  oil  of  eucalyptus  and 
eucalyptol  is  used  for  the  same  purposes,  but  eucalyptol  is  the 
refined  product  of  the  oil. 

Medical  Properties  and  Action. — Eucalyptus  is  antiseptic,  disin- 
fectant, sedative,  tonic,  diaphoretic  and  somewhat  astringent. 
When  taken  into  the  mouth,  it  excites  a  flow  of  saliva,  and 
leaves   a  hot,  pungent   taste,  and   a  persistent   and  disagreeable 


EUCALYPTUS.  399 


odor.  When  introduced  into  the  stomach,  it  causes  a  sensation 
of  warmth,  and  promotes  the  secretion  of  the  gastric  juice. 
Being  stomachic,  it  increases  the  appetite  and  the  digestive 
action,  with  increased  intestinal  secretion.  Large  doses  produce 
offensive  eructations,  a  feeling  of  weight  and  tension  at  the  epi- 
gastrium, and  indigestion,  followed  by  diarrhoea,  and  irritation 
and  congestion  of  the  kidneys.  It  increases  the  action  of  the 
heart,  lessening  the  arterial  tension,  and  causes  a  feverish  condi- 
tion. It  accelerates  the  respiratory  movements,  and  although  it 
induces  sleep  in  the  weak  and  anemic,  it  has  the  opposite  effect 
on  the  strong  and  healthy.  The  secretions  of  the  skin,  mucous 
membrane  and  kidneys  are  increased  by  it,  and  become  strongly 
odorous,  owing  to  the  presence  of  eucalyptol,  a  name  given  to 
the  oil.  The  inhalation  of  large  quantities  of  the  vapor  pro- 
duces effects  analagous  to  those  of  the  agent  when  taken  in  sub- 
stance, and  the  essential  oil  is  readily  diffusible  and  readily  im- 
pregnates the  blood. 

Therapeutic  Uses. — While  the  internal  use  of  eucalyptus  is 
contra-indicated  in  inflammatory  conditions,  it  is  a  very  efficient 
remedy  in  atonic  dyspepsia ;  chronic  gastric  and  intestinal  ca- 
tarrh, cachectic  conditions,  flatulence,  palpitation  of  the  heart, 
hysteria,  chorea,  asthma,  catarrhal  broncho-pulmonary  affections, 
chronic  diseases  of  the  liver  and  bladder,  etc.  It  is  also  em- 
ployed in  intermittent  fever,  and  during  convalescence  from 
remittent  fever.  Externally,  it  is  an  efficient  application  to  chronic 
forms  of  angina  and  tonsilitis,  to  foul  ulcers  and  wounds,  etc. 

Dose. — Of  the  Oleum  Eucalypti — TTLx  to  xv ;  its  active  princi- 
ple— Eucalyptol  is  to  be  preferred  to  the  oil  as  more  concentrated 
and  uniform  in  action.     Dose  of  eucalyptol  TTlv  to  x  in  capsules. 

Dental  Uses. — In  dental  practice,  the  decoction  of  the  leaves 
is  an  efficient  local  application  in  the  different  forms  of  stoma- 
titis, after  the  acute  stage  has  subsided.  The  tincture  and  the 
distilled  water  of  eucalyptus,  or  fluid  extract,  are  used  as  disin- 
fectant applications  in  indolent  offensive  ulcers  of  the  mucous 
membrane  of  the  mouth,  stomatitis,  pharyngitis,  etc.  The  tinc- 
ture of  eucalyptus  has  been  employed  with  advantage  to  obtund 
the  sensibility  of  dentine.     The  oil  of  eucalyptus,  either  alone 


400  DENTAL  MEDICINE. 


or  combined  with  iodoform,  forms  one  of  the  most  effective  anti- 
septics in  use,  for  the  treatment  of  putrescent  pulps  of  teeth, 
alveolar  abscess,  of  the  chronic  form,  pyorrhoea  alveolaris,  foul 
ulcers  of  the  mouth,  etc. 

No  other  preparation  appears  to  prove  more  efficient  as  an 
antiseptic  than  the  combination  of  eucalyptus  oil  and  iodoform, 
in  the  treatment  of  suppurating  conditions,  putrescent  pulp- 
canals,  necrosis,  and  caries  of  the  bones  of  the  javi^s,  etc.  The 
oil  can  be  introduced  as  an  injection,  with  an  abscess  syringe,  or 
by  means  of  a  fine  broach  armed  with  cotton,  taking  care  that 
the  agent  is  carried  to  the  seat  of  the  disease,  and  the  application 
repeated  as  often  as  necessary.  It  may  also  be  applied  by  dip- 
ping a  pledget  of  cotton  in  the  oil  and  then  in  finely  pulverized 
iodoform  (Truman),  and  carried  to  the  tooth,  as  in  cases  of 
putrescent  pulps.  It  is  also  employed  as  a  local  anaesthetic  for 
odontalgia,  and  as  an  astringent  or  styptic  in  superficial  hemor- 
rhages, mucous  discharges,  ulcerating  mucous  membrane  of  the 
mouth,  and  for  spongy,  ulcerating  gums. 

Eucalyptus  has  a  solvent  effect  upon  gutta  percha,  a  fact  which 
should  be  remembered  when  using  it  in  connection  with  tem- 
porary fillings  of  the  former  material,  or  of  Hill's  stopping. 

EuTHYMOL, — Each  fluid  ounce  is  composed  of  oil  of  eucalyptus 
3.8  minims,  thymol  15.32  grains,  oil  gaultheria  9.32  minims, 
menthol  5.64  grains,  boric  acid  loll  grains,  and  fluid  extract 
wild  indigo  11.4  minims.     Antiseptic,  Germicide  and  Deodorant. 

Euthymol  is  a  powerful  germicide  while  it  is  innocuous  in  its 
effects,  and  in  addition  to  its  deodorant  properties  it  is  detergent, 
readily  cleansing  both  the  hands  and  instruments,  and  by  its  use 
any  operation  can  be  made  aseptic,  thus  preventing  septic  infec- 
tion. It  may  be  employed  as  a  mouth  wash.  It  keeps  without 
deterioration,  and  its  liquid  form  insures  prompt  and  accurate 
dilution  at  any  instant.  It  is  applied  externally  as  a  douche,  as 
a  spray,  by  atomization,  etc.  It  does  not  stain  fabrics,  and  has 
no  unpleasant  odor. 

EuFORMAL  is  composed  of  oil  of  eucalyptus,  oil  of  gaultheria^ 
thymol,  menthol,  boric  acid,  fluid  extract  of  wild  indigo,  and 
formaldehyde   (40   per   cent.).     It   is  a  more  powerful  antiseptic. 


EUCALYPTUS. 


401 


disenfectant  and  germicide  than  euthymol,  and  combines  the 
properties  of  euthymol  with  the  germicidal  power  of  form- 
aldehyde, and  is  very  efficient  as  a  deodorant.  It  is  non-toxic, 
non-irritant,  and  does  not  stain.  It  quickly  removes  putrid  odors 
from  decomposing  animal  and  vegetable  matter,  combining  with 
sulphuretted  hydrogen  and  ammonia  bases  generally  to  form  in- 
odorous compounds.  It  removes  the  odor  of  perspiration,  and 
destroys  the  disagreeable  smell  of  the  feet,  for  which  it  is  used  in 
a  diluted  form.  It  disenfects  instruments  and  hands,  and  is  use- 
ful as  a  prophylactic  in  infectious  diseases.  It  is  of  great  value 
as  a  mouth  wash  to  remove  offensive  breath,  in  the  proportion  of 
half  a  teaspoonful  of  euformal  to  a  tumblerful  of  water  used  as 
a  gargle.     It  also  proves  useful  in  bites  and  stings  of  insects. 

IVyeth's  J4ntiseptic  Solution. — Composed  of  proportionate  com- 
binations of  eucalyptus,  gaultheria,  mentha  arvensis,  and  baptisia 
tinctoria,  with  16  grains  of  benzo-boric  acid  in  each  fluid  ounce. 


DENTAL    FORMULA. 


For  Abscess  of  Antrum. 

U .     Olei  eucalypti    .    .    .  5  ij 
Acidi  carbolic!  .    .    .  gtt.  x 

Glycerini ^ij 

Olei    gaultheria;    .    .  ^ss. 

SiGNA. — Use  as  an  injection. 


M. 


For  Suppurating  Pulps,  Ulcers,  etc. 
R.     Olei  eucalypti    .    .    .  ^j 

Iodoform! gr.  xv.    M. 

SiGXA. — Apply  as  an  injection,  by 
means  of  a  syringe;  or  on  cotton 
wrapped  on  the  end  of  a  fine  broach ; 
or  on  a  strand  of  floss-silk. 

For  Abscess  of  Antrum. 
Dr.  Geo.  L.  Parmele. 

R.     Eucalypti ^j 

Iodoform! gr-  * 

Aquce ^j.  M. 

SiGNA. — To  be  used  as  an  injection  in 
connection  with  a  tent  of   floss-silk 
saturated  with  glycerine  and  euca- 
lyptus. 
26 


For  Root  Canals  as  an  Antiseptic. 
Dr.  R.  D.  Pedley, 
R .     Olei  eucalypti  ...    2  parts 
Olei  caryoph.  ...     3  parts 

Creasoti 10  parts.  M. 

Into  this  dissolve  gum  mastich  to 
saturation,  filter  through  cotton-wool 
and  thoroughly  incorporate  with  iodo- 
form in  a  mortar  until  it  becomes  a 
solid  mass. 

SiGNA,  —  Introduce  on  floss-silk  or 
wisps  of  cotton,  and  cap  it  with  a 
disk  of  metal  and  insert  temporary 
filling. 

For  Alveolar  Pyorrhea 
{Riggs^  Disease.) 
Dr.  G.  V.  Black. 
R .     Olei  eucalypti    .    .    .  HX^c 
Acidi  carbolic!  .    .    .  y(\^c 
Olei  gaultherise      .    .  tTLxxx.  M. 
SiGNA. — Apply  by  means  of  an  abscess 
syringe. 


402  DENTAL  MEDICINE. 


EUGENOl ACETAMID. 

Eugenol-acetamid  is  prepared  as  follows :  Monochloracetic 
acid  is  acted  upon  by  eugenol  sodium,  when  eugenol  acetic  acid 
results.  This  acid  is  treated  with  alcohol  and  hydrochloric  acid, 
by  which  it  is  converted  into  the  "  ethylester  of  eugenol-acetic 
acid.  Strong  alcoholic  ammonia  converts  this  into  eugenol- 
acetamid.  As  crystallized  from  water  it  occurs  in  lustrous 
scales;   from  alcohol  in  fine  needles  ;   melting  at  iio°." 

Therapeutic  and  Dental  Uses. —  It  is  claimed  for  eugenol- 
acetamid,  that  when  it  is  applied  in  the  form  of  a  fine  powder, 
it  produces  local  anaesthesia  without  any  caustic  action,  similar  to 
cocaine.  It  has  been  successfully  employed  as  a  local  anaesthetic 
in  the  treatment  of  wounds ;  and  is  also  recommended  as  an 
obtundent  in  the  extraction  of  teeth. 


EUROPHEN— ISOBUTYL-ORTHO-CRESOL-IODIDE. 

Derivation. — Europhen  is  obtained  by  the  action  of  isobutyl- 
alcohol  upon  <?-cresol  in  the  presence  of  chloride  of  zinc  at  an 
elevated  temperature,  producing  isobutylcresol.  This  is  then 
acted  upon  by  iodine  in  potassium  iodide,  the  resulting  iodine 
compound  being  isobutylorthocresoliodide  or  europhen.  Euro- 
phen is  an  amorphous  yellow  precipitate,  which  is  separated  by 
filtration  and  cleansed  by  washing,  and  afterward  dried  in  the 
dark  at  ordinary  temperature. 

The  percentage  of  iodine  in  europhen  is  about  27.6,  which 
corresponds  accurately  with  a  proportion  of  one  atom  of  iodine 
to  two  molecules  of  isobutylcresol,  Europhen  is  resinous  to  the 
touch,  and  when  applied  to  the  mucous  membrane  or  to  the  skin, 
adheres  tenaciously.  It  possesses  an  aromatic  odor,  which,  how- 
ever, disappears  when  it  is  made  into  a  solution  or  mixture.  It 
is  insoluble  in  glycerine  or  water,  but  readily  soluble  in  alcohol 
(30  per  cent.),  ether  or  chloroform  (equal  weight),  and  such  com- 
pounds of  these  agents  as  collodion,  and  liquid  gutta  percha,  and 
also  in  fatty  oils.  A  25  per  cent,  solution  of  europhen  can  be 
made  by  rubbing  it  at  a  low  temperature  in  olive  oil,  which, 
after  being  filtered,  remains  clear  for  a  long  period.     In  contact 


EUROPHEN.  403 


with  wound  secretions,  it  gives  off  slowly  small  quantities  of 
iodine,  which  are  immediately  combined  again,  and  form  the 
soluble  compound.  The  chief  action  of  europhen  can  be  as- 
cribed to  this  formation  in  the  nascent  state ;  hence  there  is 
present  in  this  agent  very  small  quantities  of  free  iodine, 
which  form  during  the  drying  process  and  cannot  be  removed 
from  it, — the  percentage  has  been  estimated  at  about  0.03  per 
cent. 

On  account  of  europhen  being  easily  decomposed,  all  starch 
mixed  with  it  and  also  mixtures  of  metallic  oxides,  are  contra- 
indicated.  Talcum  is  employed  to  make  with  it  a  thick  paste, 
and  simple  mixtures  of  it  with  fats,  vaseline  or  lanoline  are  very 
durable,  especially  the  latter.  Europhen  solutions  must  be  pre- 
pared at  a  low  temperature,  and  they  must  be  protected  from 
the  light  and  moisture. 

Therapeutic  Action. — Europhen  is  employed  as  a  substitute  for 
iodoform  in  the  treatment  of  wounds,  as,  it  is  claimed,  that  a 
given  weight  of  europhen  will  cover  five  times  as  large  a  wound 
surface  as  the  same  weight  of  iodoform ;  and  also  that  it  will 
prove  efficacious  in  cases  where  iodoform  fails. 

Its  freedom  from  odor  and  non-toxic  effects  are  also  advan- 
tages over  iodoform. 

Dental  Uses. — Europhen  is  employed  in  dental  practice  for 
irritation  and  inflammation  of  the  oral  mucous  membrane,  such 
as  may  result  from  artificial  dentures,  crown-  and  bridge-work, 
as  it  acts  promptly  and  efficiently  in  reducing  the  swelling  and 
soreness ;  also  in  syphilitic  mucous  patches  on  the  cheeks  and 
tongue ;  it  is  also  employed  to  relieve  the  pain  of  inflamed  or 
suppurating  pulps  of  teeth  on  account  of  its  rapid  action.  Dr. 
A.  W.  Harlan  recommends  for  such  purposes,  powdered  europhen 
rubbed  up  with  lanolin  (25  parts  of  europhen  to  75  parts  of 
lanolin).  He  has  also  found  such  a  combination  to  be  of  service 
in  the  after-dressing  of  the  pockets  of  alveolar  pyorrhoea,  and  as 
a  parasiticide,  and  as  a  dressing  in  empyema  of  the  antrum. 

The  powdered  europhen  is  also  applied  in  gingival  inflamma- 
tions resulting  from  setting  crowns  and  bridges,  with  great  suc- 
cess ;   also  to  an  inflamed  and  suppurating  pulp. 


404  DENTAL  MEDICINE. 


FERRUM— IRON. 

Chemical  analysis  demonstrates  the  presence  of  iron  in  the 
blood,  the  gastric  juice,  chyle,  lymph,  bile,  milk,  urine  and  the 
pigment  of  the  eye ;  and,  although  metallic  iron  is  inert,  yet, 
when  it  reaches  the  stomach,  it  is  dissolved  by  the  acids,  and 
thus  acquires  molecular  activity.  By  its  oxidation  in  the  stomach 
hydrogen  is  set  free,  which  in  its  nascent  state  unites  with  sul- 
phur, forming  sulphuretted  hydrogen. 

Medical  Properties  and  Jction. — The  salts  of  iron  act  through 
and  upon  the  blood,  improving  its  quality  and  increasing  its 
quantity,  and  hence  they  are  termed  "  hematinic."  These  salts 
of  iron  are  absorbed  into  the  system,  and  are  detected  in  the 
blood,  urine,  etc.,  and  under  their  use  the  appetite  increases,  the 
digestion  is  improved,  the  pulse  increases  in  frequency  and  ful- 
ness, the  health  becomes  better,  and  there  is  an  increase  in  flesh 
and  an  improvement  in  color;  hence  they  are  "restoratives." 
As  these  salts  of  iron  in  large  doses  cause  nausea  and  vomiting, 
being  irritant  poisons,  and  even  small  doses,  when  administered 
for  a  long  period,  exhaust  the  gastric  glands  by  over-stimulation, 
their  use  is  contra-indicated  in  a  plethoric  condition,  especially 
when  accompanied  with  a  hemorrhagic  tendency,  or  when  there 
is  an  atheromatous  state  of  the  cerebral  vessels.  Certain  of  these 
salts,  such  as  the  sulphates,  the  chlorides,  and  the  nitrates,  pos- 
sess a  high  degree  of  astringency,  and  when  taken  internally  pro- 
duce constipation.  Brought  in  contact  with  the  blood,  they  coag- 
ulate it,  and  solidify  the  albuminous  elements  of  the  tissues,  being 
powerful  "  hemostatics." 

Without  great  care  is  exercised  in  the  internal  administration 
of  iron,  owing  to  the  acidity  and  astringent  property  of  many  of 
these  preparations,  injury  results  to  the  teeth,  upon  which  they 
act  with  great  energy.  The  tincture  of  the  chloride  and  the 
sulphate,  as  shown  by  the  experiments  of  Dr.  Smith,  of  Edin- 
burgh, Scotland,  are  more  corrosive  than  the  wine  of  iron,  and 
even  more  injurious  than  the  compounds  of  iron  with  the  vege- 
table acids.  The  use  of  an  alkaline  gargle  of  carbonate  of  soda, 
or  prepared  chalk,  or  solution  of  ammonia,  before  and  after  the 
taking  of  the  iron   preparation  into  the  mouth,  and  the  subse- 


IRON.  405 

quent  employment  of  an  antacid  dentifrice,  will  obviate  the 
injurious  effects  of  these  salts  of  iron  upon  the  teeth.  While 
the  carbonate  of  iron  in  the  form  of  pill,  nor  the  reduced  iron, 
are  injurious  to  the  teeth  by  direct  action,  yet  eructations  of 
hydrogen  compounds  produced  by  their  ingestion  may  injure  the 
teeth. 

The  use  of  a  tube  carried  well  back  in  the  mouth  and  the 
iron  preparation  well  diluted,  should  be  preceded  and  followed  by 
the  alkaline  solution.  The  preparation  known  as  dialysed  iron 
— Ferrum  Dialysatum — which  is  iron  in  the  colloid  state,  made 
by  the  process  of  diffusion,  is  odorless,  without  the  styptic  taste 
of  the  other  preparations,  and  does  not  discolor  the  teeth,  being 
free  from  irritant  action  ;  neither  does  it  cause  constipation,  and 
hence  it  is  the  best  form  in  which  to  administer  iron.  The  dose 
of  dialysed  iron  is  ITtv  to  5j. 

Therapeutic  Uses  of  Iron. — Iron  is  an  efficient  tonic,  and  pro- 
motes the  appetite  and  the  digestion  ;  hence  it  is  employed  in 
anemia,  chlorosis,  combined  with  quinine  in  chronic  malarial 
affections,  syphilitic  cachexia,  acute  rheumatism,  erysipelas, 
diphtheria,  scrofula,  rickets,  neuralgia  depending  on  anemia, 
epilepsy  in  weak,  anemic  subjects,  fatty  degeneration  of  the 
heart,  passive  forms  of  hemorrhage  due  to  anemia,  albuminuria, 
etc.,  etc.  Externally,  the  styptic  preparations  of  iron  are  em- 
ployed to  arrest  hemorrhage — hemorrhage  from  leech  bites,  hem- 
orrhage following  the  extraction  of  teeth,  hemorrhage  resulting 
from  wounds  and  surgical  operations,  etc.,  etc. 

[For  doses  of  the  various  preparations  of  iron,  see  "  Table  of 
Doses."] 

Chloride  of  Iron — Ferri  Chlorldum — Perchloride  of  iron. 
Formula^  FcjCIg,  is  obtained  by  heating  iron  wire  with  hydro- 
chloric acid,  and  afterward  converting  the  ferrous  chloride  thus 
formed  into  ferric  chloride  by  heating  it  with  hydrochloric  and 
nitric  acids.  It  is  in  the  form  of  crystalline  masses  of  an  orange 
yellow  color,  inodorous  and  of  a  strong  styptic  taste.  It  is  deli- 
quescent and  readily  soluble  in  water,  alcohol  and  ether.  It  is 
used  internally  in  the  form  of  a  tincture —  Tinctura  Ferri  Chloridi. 
Dose^  TTLv-xx. 


406  DENTAL  MEDICINE. 


Externally  the  chloride  of  iron  is  employed  as  a  styptic  and  as 
an  astringent,  for  the  latter  purpose  being  in  the  form  of  solu- 
tions of  various  strength. 

Dental  Uses. — In  dental  practice  the  chloride  of  iron  is  used 
internally  for  the  treatment  of  neuralgia  when  it  is  attended 
with  anemia ;  also  externally,  for  the  arrest  of  alveolar  hemor- 
rhage, although  the  preference  is  given  to  the  solution  or  powder  of 
the  subsulphate.  The  chloride  of  iron  may  be  used  in  the  semi- 
deliquesced  or  crystallized  form,  or  in  solution — Liquor  Ferri 
Perchloridi — which  is  preferred  by  some  to  the  crystallized.  To 
bleeding  surfaces  it  is  applied  in  the  proportion  of  5ss  to  5vj  to 
the  ounce  of  water.  One  part  of  the  chloride  gradually  added 
to  six  parts  of  collodion,  in  the  form  of  a  yellowish-red,  limpid 
liquid,  makes  a  valuable  styptic.  Chloride  of  iron  is  also  useful 
as  an  application  to  fungous  tumors. 

Reduced  Iron — Ferrum  Reductutn — is  metallic  iron  in  the  form 
of  a  fine  powder,  obtained  by  the  reduction  of  ferric  oxide  by  hy- 
drogen.    Dose. — Gr.  j  to  gr.  v. 

Solution  of  Subsulphate  of  Iron — Liquor  Ferri  Subsulphatis — Mon- 
sel's  Solution — Formula:  2  Fe203(S04)3 — is  composed  of  sulphate 
of  iron,  Sxij  ;  sulphuric  acid,  5ji  and  gr.  xxx;  nitric  acid,  gr. 
ccclx.  It  is  of  a  syrupy  consistence  and  a  ruby  red  or  dark 
brown  color,  no  odor  or  acrid  taste,  but  possesses  powerful  as- 
tringent properties.  When  employed  for  the  arrest  of  alveolar 
hemorrhage  from  tooth-extraction  it  is  liable  to  cause  sloughing 
of  the  bleeding  tissues,  and  if  used  it  should  be  in  weak  solution, 
and  carefully  watched. 

Powdered  Subsulphate  of  Iron. — Pulvis  Ferri  Subsulphatis — Mon- 
sel's  Powder — is  in  the  form  of  a  yellow  powder,  and  possesses 
the  same  astringent  and  other  properties  as  the  solution,  and  is 
applied  as  a  styptic  in  alveolar  hemorrhage  with  much  greater 
convenience  than  the  liquid  form. 

Medical  Properties  and  Action. — Monsel's  solution  and  powder 
act  topically  as  powerful  astringents  and  mild  caustics,  and  are 
considered  to  be  among  the  best  styptics  in  use.  These  styptics 
combine  with  albumen  and  form  a  pale  yellow  compound,  and  on 
this  property  depends  their  chemical  action  on  the  tissues  of  the 


IRON.  4,0X 

body.  Internally  administered,  they  act  like  the  sulphate  of  iron, 
their  remote  effect  being  tonic  and  hemostatic.  In  small  doses 
they  exert  an  astringent  effect  on  the  gastro-intestinal  mucous 
membrane,  diminishing  the  quantity  of  fluids  secreted  or  exhaled  ; 
hence  their  continued  use  will  cause  constipation. 

Monsel's  preparations  of  iron  are  principally  used  externally 
for  hemorrhage  from  bleeding  vessels.  When  employed  inter- 
nally it  is  for  the  arrest  of  hemorrhage  from  remote  organs. 

Therapeutic  Uses. — The  solution  and  powder  of  the  subsul- 
phate  of  iron  are  used  internally  for  hemorrhage  from  the  stom- 
ach and  bowels.  Externally,  for  hemorrhage,  varicose  ulcers, 
etc.,  etc. 

Dose. — Of  the  solution  of  subsulphate  of  iron,  gtt.  v  to  gtt.  x, 
twice  a  day  in  some  bitter  infusion.  Of  the  powdered  subsul- 
phate of  iron  the  dose  is  gr.  v  to  gr.  xv.  The  solution  is  also 
given  in  small  doses  with  the  sulphate  of  magnesia,  and  as  an  ar- 
tificial chalybeate  purging  water. 

Dental  Uses. — In  dental  practice,  Monsel's  solution  and  pow- 
der are  principally  employed  for  arresting  hemorrhage  following 
the  extraction  of  teeth,  hemorrhage  from  leech  bites,  and  also 
from  other  causes,  such  as  wounds  of  the  gums  and  mucous  mem- 
brane, in  the  treatment  of  ulcers  of  the  mouth  ;  and  the  solution, 
diluted  with  water,  forms  a  serviceable  application  for  abraded 
and  inflammed  mucous  surfaces. 

Dialysed  iron  is  suggested  as  a  local  application  for  soreness  of 
teeth  following  devitalization  by  arsenious  acid,  and  removal  of 
pulp,  the  root  canal  also  packed  with  cotton,  moistened  with 
the  iron  preparation.  It  is  an  antidote  for  arsenious  acid,  and  is 
locally  applied  after  the  removal  of  arsenical  devitalizing  mix- 
tures, with  good  effects. 

For  Hemorrhage  following  the  Extraction  of  Teeth. — 
After  carefully  cleansing  the  bleeding  cavity  as  thoroughly  as  pos- 
sible, the  styptic  should  be  applied  on  a  pellet  of  cotton,  or,  in 
case  the  powdered  subsulphate  of  iron  is  employed,  on  a  pellet  of 
cotton  previously  dipped  in  sandarach  varnish,  to  which  the 
powder  will  adhere,  and  inserted  over  the  mouth  of  the  bleeding 
vessel  at  the  apex  of  the  alveolar  cavity.     Cotton  should  then  be 


408  DENTAL  MEDICINE. 

inserted  over  the  styptic  preparation,  and  the  alveolar  cavity  be 
thoroughly  filled  up.  If  necessary,  a  compress,  made  from  a 
cork,  or  softened  modeling  composition,  should  be  applied  over 
the  cotton  filling  the  cavity  and  held  in  place  by  the  opposing 
teeth,  when  the  mouth  is  closed. 

DENTAL    FORMULA. 

For  Hemorrhage  from  Extraction  of  Teeth. 
Steere. 
B .         Liq.  ferri  persulph., 

Sodium  chlor aa  partes  requales.         M. 

SiGNA. — Apply  on  cotton  to  bleeding  cavity  and  secure  by  covering 
with  a  roll  of  cotton  cloth. 

For  Hemorrhage  after  Lancing  Gums  of  Children. 
Dr.  J.  W.  White. 
Where  oozing  of  blood  persists  in  spite  of  local  treatment : 

K .         Tinct.  ferri  chloridi f  3  ss 

Acid,  acetic  dil f^j 

Liq.  ammonii  acet l"^] 

Ext.  ergot,  fid f  j  ij 

Syr.  simp f^ss 

Aquae  q.s.  ad ^§''j-  M. 

SiGNA. — A  teaspoonful  every  3  hours  for  a  child  6  months  old. 

FORMALIN— FORMALINE. 

Derivation. — Formalin  is  a  forty  per  cent,  aqueous  solution  of 
formaldehyde,  (CHgO).  It  is  a  colorless,  neutral,  volatile  liquid 
with  a  pungent  odor  and  slightly  irritating  taste.  It  mixes  in  all 
proportions  with  water,  and  a  solution  of  any  required  strength  can 
be  readily  made.  Taken  internally  in  small  doses  it  does  not  pro- 
duce any  toxic  effect. 

Formaldehyde,  formyl  or  formol,  is  a  gaseous  body,  obtained  by 
the  oxidation  of  methylic  alcohol  at  a  moderately  high  tempera- 
ture; and,  according  to  Lilly,  has  the  chemical  property  of  unit- 
ing with  sulphuretted  or  nitrogenous  products  of  decay,  fermen- 
tation or  decomposition,  forming  true  chemical  compounds  which 
are  odorless  and  sterile ;  and  these  compounds  are  in  most  cases 
actually  antiseptic  themselves ;  hence  it  is  from  this  property  of 


FORMALINE.  409 


combining  with  albuminous  or  nitrogenous  bodies  that  formalde- 
hyde derives  its  germicidal  and  bactericidal  powers,  since  bacteria 
and  micro-organisms  generally  are  not  only  albumenoid  in  char- 
acter, but  their  food  is  mainly  albumenoid  ;  and  when  formalde- 
hyde is  present,  it  combines  with  both  the  bacteria  and  their  food, 
thus  destroying  them,  as  well  as  the  possibility  of  their  existence. 

Medicinal  Properties^  etc. — The  germicidal  and  antiseptic  action 
of  formaldehyde  was  demonstrated  by  Low,  Aronson,  Berlioz 
and  Frillat ;  also  by  I.  Stahl,  who  found  that  formalin  is  equal  in 
germicidal  power  to  corrosive  sublimate,  and  under  certain  con- 
ditions superior  where  albuminoid  solutions  are  concerned.  In 
large  rooms  a  2.5  volume  per  cent,  of  formalin  in  the  air  destroyed 
all  micro-organisms  in  a  quarter  of  an  hour.  When  allowed  to 
evaporate  in  the  presence  of  wool,  gauze-bandages,  or  other  dress- 
ing material,  the  vapors  of  formalin  condensed  upon  the  fabrics 
in  solid  form  (paraformalin)  and  so  disinfected  them.  Hence 
dressing  materials  impregnated  with  formalin  become  perfectly 
sterile,  and  can  immediately  be  used  as  antiseptic  dressing.  The 
vapor  from  the  spray  by  a  steam  atomizer  above  the  patient's 
head  has  proven  efficient  in  whooping-cough  and  chronic  bron- 
chitis. 

Formaldehyde  is  relatively  non-poisonous,  but  when  brought  in 
contact  with  the  skin,  undiluted,  causes  a  tanning  effect,  making 
it  impermeable,  and  finally  causing  necrosis.  This  action  is  due 
to  the  property  formalin  possesses  of  readily  penetrating  living 
and  dead  tissue,  and  combining  with  it.  Formalin  readily  and 
quickly  influences  both  albumin  and  gelatine,  changing  them  into 
a  tough  coagulum  which  does  not  lose  its  form,  and  possesses 
persistent  antiseptic  properties  for  certain  micro-organisms. 
Formalin  attacks  only  the  substance  of  the  contagious  material, 
leaving  intact  the  articles  treated,  whether  of  organic  or  inorganic 
nature.  It  is  also  very  readily  employed  under  all  circumstances, 
either  in  liquid  or  gaseous  form.  Its  specific  gravity  closely 
approximates  that  of  air,  hence  its  power  of  keeping  the  atmos- 
phere of  an  enclosed  space  uniformly  impregnated  with  formalin 
vapor.  Inhaled  in  quantity,  formalin  has  marked  toxic  prop- 
erties. 


410  DENTAL  MEDICINE. 


Therapeutic  Uses. — Formaldehyde  is  a  very  reliable  and  useful 
germicide,  antiseptic,  and  disinfectant.  It  is  non-toxic,  active, 
and  permanent,  and  has  no  destructive  action  on  vegetable  or 
animal  substances  when  locally  applied  in  the  form  of  formalin. 
Being  of  low  specific  gravity,  the  vapor  of  formaldehyde  mixes 
readily  with  the  air,  and  possesses  more  penetrating  power  in  loose 
fabrics  than  any  other  germicide.  Its  activity  as  a  germicide 
closely  approaches,  if  it  does  not  equal,  that  of  corrosive  sublimate. 
In  the  strength  of  i  to  2,000  it  is  used  in  place  of  the  bichloride 
of  mercury  for  injections  in  large  cavities,  etc. 

Dental  Uses. — In  dental  practice,  formalin  is  employed  as  an 
antiseptic  and  deodorizer  in  the  treatment  of  putrescent  pulps, 
alveolar  abscesses,  etc.  Also  as  a  local  application  to  ulcers  of 
the  mouth,  abrasions,  etc.  One  and  a  half  per  cent,  solutions 
are  used  as  gargles  and  mouth  washes ;  also,  two  and  one-half  per 
cent,  solutions  for  ulcers,  skin  diseases,  etc.  To  make  a  one  per 
cent,  solution,  one  part  of  formalin  is  added  to  40  parts  of  water 
(i  oz.  to  2^  pints).  For  sterilizing  cavities  in  teeth,  a  twenty 
per  cent,  solution  of  formalin  is  very  effective,  and  more  especially 
if  the  cavity  is  large,  or  any  decomposed  dentine  is  allowed  to 
remain  as  a  covering  to  the  pulp.  It  is  also  serviceable  in 
putrescent  canals,  and  for  rendering  devitalized  pulps  hard  and 
leathery  after  the  action  of  arsenious  acid ;  in  such  cases  a  20  per 
cent,  solution  is  applied  on  cotton  and  permitted  to  remain  for 
three  to  six  days.  For  pulp-exposure  a  2  per  cent,  solution  may 
be  applied  before  capping.  While  non-toxic,  it  requires  care  in 
its  use,  as  it  is  an  intense  irritant  to  flesh.  A  4  per  cent,  solution 
will  remove  putrescent  pulp-odor  from  the  fingers. 

Paraform.,  or  polymerized  formaldehyde,  is  a  colorless  crystal- 
line powder,  insoluble  in  water,  which  when  heated  gives  off 
formaldehyde  gas.  This  gas  is  recommended  by  Dr.  H.  O.  Reik 
as  an  excellent  sterilizer  of  instruments,  napkins,  towels,  etc. 
Paraform  pastilles  are  placed  in  a  small  air-tight  chamber  together 
with  the  articles  to  be  sterilized,  and  formaldehyde  gas  liberated 
by  means  of  an  alcohol  lamp  placed  underneath. 

Glutol  is  a  compound  of  formaldehyde  and  gelatin,  in  the  form 
of  a  powder,  which  is  antiseptic,  and  while  it  dries  the  surface  of 


WINTERGREEN.  411 

wounds  and  ulcers,  seals  them  and  renders  them  sterile.     It  is  an 
efficient  dressing  for  burns. 

GAULTHERIA— WINTERGREEN. 
PARTRIDGE    BERRY TEA    BERRY. 

Source. — Gaultheria  is  obtained  from  the  leaves  of  the  gaultheria 
procumbens  (Ericaceae),  a  small  plant  common  to  the  woods  of 
North  America.  The  leaves  contain  a  volatile  oil,  arbutin, 
urson,  ericolin,  tannic  acid,  etc.,  and  the  taste  is  aromatic,  some- 
what bitter,  and  astringent.  The  volatile  oil  consists  principally  of 
gautheriline  and  methyl  salicylate,  which  yield  a  pure  salicylic  acid. 

Oleum  Gaultheria. — The  oil  of  gaultheria  is  antiseptic  and 
antipyretic,  and  is  administered  in  doses  of  Hlx-xx  in  articular 
rheumatism,  and  locally  is  used  as  an  antiseptic  in  wounds  and 
cystitis.  The  spirit  of  gaultheria — spiritus  gaultheria — is  used 
for  flavoring.  The  infusion  is  used  as  a  gelactagogue  and  em- 
menagogue,  and  is  often  added  to  liniments  for  rheumatic  pains 
and  swollen  joints. 

Dental  Uses. — The  oil  of  gaultheria,  one  of  the  essential  oils, 
is  used  in  dental  practice  as  an  antiseptic,  either  alone  or  more 
generally  in  combination  with  other  agents  in  the  treatment  of 
putrid  root  canals,  alveolar  abscesses,  etc.,  and  as  an  ingredient 
of  local  anaesthetic  mixtures. 

DENTAL    FORMULA. 

For  Abscesses  and  Putrid  Root  Canals. 

Dr.  Black. 

R .       Carbolic  acid  (melted  crystals)      i  part 

Oil  of  cassia 2  parts 

Oil  of  gaultheria 3  parts.  M. 

This  is  the  I,  2,  3,  mixture. 

Local  AncEsthetic. 
De  Kay. 

R .       01.  gaultheriae 5  ij 

Chloroformi ^j 

Ether  sulph." ^j 

Chloral  hydrat ^  ij 

01.  caryophylli ^iv 

Alchoholis ^'ss.  M. 

SiGNA. —  Apply  with  cotton  pressed  upon  each  side  of  tlie  tooth. 


412  DENTAL  MEDICINE. 


GELSEMIUM— YELLOW  JASMINE. 

Source. — Gelsemium  is  obtained  from  the  root  of  the  gehemium 
sempervirens — yellow  jasmine — woodbine,  belonging  to  the  natural 
order  Apocynaceae,  which  grows  plentifully  in  the  southern  United 
States.  The  root  is  of  a  brownish  color  externally,  and  a  grayish 
color  within,  and  is  sold  in  small  pieces,  from  one-half  to  two 
inches  in  length,  and  a  quarter  of  an  inch  in  thickness,  being  hard 
and  slightly  cracked  longitudinally.  It  has  a  bitter  taste,  and  an 
aromatic  odor,  somewhat  like  that  of  green  tea. 

Medical  Properties  and  Action. — Gelsemium  has  a  depressing 
and  sedative  influence  upon  the  nervous  centres,  and  diminishes 
the  force  and  frequency  of  the  heart's  action.  It  contains  a  very 
powerful  alkaloid,  gelsemia  or  gelsetnina^  which  is  colorless,  odor- 
less, with  an  intensely  bitter  taste. 

Gelsemium,  in  moderate  doses,  causes  a  languid  feeling,  attended 
with  mental  calmness,  slow  action  of  the  heart,  drooping  eyelids, 
dilatation  of  the  pupil,  and  some  feebleness  of  muscular  move- 
ments. In  larger  doses  it  causes  vertigo,  double  vision,  am- 
blyopia, paralysis  of  the  muscle  that  elevates  the  upper  eyelid,  so 
that  it  cannot  be  raised,  dilated  pupil,  labored  respiration,  on 
account  of  its  effect  upon  the  respiratory  muscles,  slow  and 
feeble  movement  of  the  heart,  great  muscular  weakness,  and  a 
reduced  sensibility  to  pain  and  touch.  Such  effects  occur  about 
half  an  hour  after  the  gelsemium  is  taken,  and  continue  for  two 
or  three  hours,  when  they  disappear. 

When  poisonous  doses  are  taken,  all  of  the  symptoms  de- 
scribed above  occur  in  a  more  intense  degree,  and  there  is  first 
an  unsteady  gait,  until  all  muscular  power  is  lost,  the 'lower  jaw 
drops,  the  muscles  of  the  tongue  are  paralyzed,  speech  being  im- 
possible, the  respirations  are  very  labored,  slight  and  irregular, 
and  the  action  of  the  heart  weak,  feeble  and  intermittent,  and 
generally  the  skin  is  covered  with  a  profuse  perspiration.  Death 
occurs  from  asphyxia,  but  consciousness  is  preserved  until  near 
the  end,  which  is  generally  calm,  and  not  disturbed  by  convul- 
sions. 

Therapeutic  Uses. — Gelsemium  is  internally  administered  in 
tetanus,  mania,  convulsive  or  spasmodic  cough,  such  as  whoop- 


GLUSIDE.  413 

ing-cough,  pneumonia,  remittent  and  typho-malarial  fevers, 
ovarian  and  other  forms  of  neuralgia,  cerebro-spinal  meningitis, 
pleuritis,  etc.,  etc. 

Dose. — Of  the  fluid  extract  of  gelsemium — Extractum  Gelsemii 
Fluidum — the  only  officinal  preparation,  lUv  to  TTLxv.  Of  the 
tincture  of  gelsemium — Tinctura  Gelsemii — (gelsemium  5iv,  al- 
cohol, Oj,)  the  dose  is  gtt.  x  to  gtt.  xx.  The  fluid  extract  is 
preferable  for  administration  j  but  one  fluidrachm  of  this  has 
caused  death.     Dose  of  the  alkaloid  gelsemia.,  gr.  ^i^  to  gr.  ^ly. 

Dental  Uses. — Gelsemium  is  greatly  extolled  as  a  remedy  for 
neuralgia  of  the  fifth  nerve,  often  affording  permanent  relief,  es- 
pecially when  the  affection  is  associated  with  diseased  teeth.  The 
dose  may  be  repeated  at  any  time  after  an  hour  and  a  half,  if  the 
pain  is  not  relieved  ;  a  third  dose  is  seldom  required.  In  neu- 
ralgia of  the  face  or  head,  three-minim  doses  of  the  tincture  of 
gelsemium  every  half  hour,  will  often  act  very  beneficially,  and 
leave  no  ill  effects.  Owing  to  the  toxic  effects  of  this  drug,  care 
is  necessary  that  the  dose  is  a  moderate  one,  and  the  symptoms 
carefully  observed. 

DENTAL  FORMULAE. 
For  Neuralgia  from  Devitalized  Teeth.       SiGNA. — Give   i  to  3  pills  to  an  adult 
R.     Tinct.  gelsemii  .    .    .    .  gtt.x  in  the  24  hours. 

Tinct.  aconiti        .    .    .  gtt.v 

AquK ^iv.    M. 

SiGNA. — One  teaspoonful  every  hour.  For  Dentalgia. 

For  Odontalgia,  Internal  Remedy.  ^'  '^  •••IIL 

Tinct.  ferri  perchlori  .  HI  x 
Dr.  Dunoycer.  e 

byr.  aurantii    .    .    .    .  ^ss 

R,     Gelsemium     ....       i  milligr.  ^quje ad.  gj.     M. 

Aconitine(cryst.)    .    .   X  milligr.  SiGNA.— For  I  dose.     To  be  repeated 

Valerianate  of  quinine  5  centigr.  thrice  daily. 

For  one  pill. 


GLUSIDUM— GLUSIDE. 

Formula. — C6H4CO,S02,NH.    Synonyms. — Saccharin,    Benzol- 
Sulphonic-imide. 

Source. — Gluside  is  obtained  from  toluene^  a  coal-tar  derivative. 


414  DENTAL  MEDICINE. 


It  is  in  the  form  of  a  light  white  crystalline  powder,  with  a  de- 
cidedly sweet  taste. 

Therapeutic  Uses. — Gluside  is  used  as  a  sweetening  agent  to 
cover  the  taste  of  nauseous  medicines.  It  is  also  antiseptic  and 
is  administered  in  diabetes,  and  other  diseases  where  sugar  is  con- 
tra-indicated. In  alcoholic  solutions  it  has  a  very  decided  action 
on  the  bacteria  of  the  oral  cavity,  as  stated  by  Dr.  Miller. 

Dose. — Gr.  ss  to  ij  or  more. 

GLYCERINUM— GLYCERIN. 

Formula. — C3H5(OH)3.     Sp.  gr.  1.25. 

Source. — Glycerin  is  obtained  from  the  saponification  of  fats 
and  fixed  oils,  and  contains  a  small  percentage  of  water.  It  is 
a  colorless,  inodorous,  syrupy  liquid,  of  a  sweet  taste,  and  freely 
soluble  in  water  and  alcohol,  but  not  in  ether  or  chloroform. 

Medical  Properties  and  Action. — Glycerin  is  nutrient  and  emol- 
lient, possessing  considerable  power  as  a  solvent  and  preservative. 
The  addition  of  i^,  ^,  or  even  ^^  part  of  glycerin  to  a  lotion 
or  poultice,  or  an  external  application,  renders  it  particularly 
emollient  and  soothing.  It  keeps  the  parts  moistened  and  soft, 
and  corrects  or  prevents  the  disagreeable  odor  of  discharges,  and 
it  does  not  evaporate  or  dry  at  an  ordinary  teniperature.  Gly- 
cerin dissolves  carbolic  acid,  creasote,  tannic  acid,  borax,  iodine, 
quinine,  iodide  of  potassium,  gallic  acid,  etc.,  and  its  uses  as  a 
solvent  and  a  vehicle  for  other  remedies  are  very  numerous.  It 
has  been  prescribed  as  a  substitute  for  cod-liver  oil,  where  the 
latter  nauseates.  Officinal  solutions  of  medicinal  agents  in 
glycerin  are  known  as  glycerites  {glyceritd). 

Therapeutic  Uses. — Glycenn  is  rarely  used  alone  as  an  internal 
remedy,  its  chief  use  being  external,  or  in  combination  with  other 
medicinal  substances.  It  has  been  prescribed  in  phthisis,  diabetes, 
acne ;  externally,  as  an  emollient  in  acute  coryza,  chronic  follicu- 
lar pharyngitis,  chapped  hands  and  face,  fissures,  skin  diseases, 
dressing  for  wounds  and  ulcerated  surfaces,  and  as  a  vehicle  for 
the  application  of  astringents  to  the  eye  ;  also  to  soften  cerumen 
and  for  the  removal  of  insects  from  the  ear,  and  for  diminishing 
the  secretion  of  pus  j  also  in  burns,  abraded  surfaces,  erysipelas. 


GLYCERIN.  415 


etc.  It  has  also  been  employed  in  smallpox  as  an  emollient  and 
to  prevent  pitting,  a  mixture  of  one  part  of  glycerin  and  two 
parts  of  rose  water  being  applied,  after  the  pustules  have  broken 
and  the  discharge  has  commenced  to  dry.  It  should  be  applied  for  a 
few  days  until  the  scabs  begin  to  loosen.  Glycerin  is  also  used  in 
croup,  locally  applied  to  the  glottis  ;  also  in  deafness,  where  the 
auditory  canal  is  dry  and  inelastic.  For  an  emollient  application 
it  is  frequently  combined  with  other  agents,  and  used  in  the  form 
of  an  ointment  or  embrocation.  Five  parts  of  glycerin  rubbed 
up  in  a  mortar  with  four  parts  of  yolk  of  egg,  forms  a  compound 
which  prevents  the  action  of  the  air  on  irritated  broken  or  abraded 
surfaces,  and  is  soothing  in  erysipelas,  cutaneous  affections,  etc. 
Although  glycerin  is  so  bland  in  its  general  character,  yet  it  pro- 
duces a  smarting  sensation  when  first  applied  to  an  abraded  sur- 
face of  the  skin ;  such  an  effect  is  thought  to  be  due  to  the  affin- 
ity of  glycerin  for  moisture,  which  it  abstracts  from  the  skin  so 
rapidly  as  to  cause  the  smarting  sensation  ;  mixing  the  glycerin 
with  a  little  water  will  obviate  this.  Pure  glycerin,  when  mixed 
with  water,  will  raise  the  temperature  eight  or  ten  degrees,  and 
hence  the  two  should  be  combined  previous  to  the  application. 

Dose. — Of  glycerin,  5j   to  oij- 

Dental  Uses. — Glycerine  is  a  useful  agent  in  dental  practice 
as  a  solvent  and  emollient,  as  a  solvent  alone,  and  as  both  solvent 
and  emollient,  when  combined  with  other  substances. 

It  is  employed  with  great  benefit  in  such  diseases  of  the  mu- 
cous membrane  of  the  mouth,  as  the  different  forms  of  stomatitis, 
ulcers  of  the  mouth,  aphthae,  alveolar  abscess,  abraded  surfaces 
from  the  irritation  of  acrid  substances,  artificial  teeth,  etc. 

In  the  treatment  of  inflamed  and  ulcerated  conditions  of 
the  mucous  membrane,  it  is  frequently  combined  with  borax,  and 
for  chronic  alveolar  abscess,  after  the  use  of  more  active  agents, 
and  diseases  of  mucous  membrane,  it  is  combined  with  carbolic 
acid,  iodine,  sulphite  of  soda,  etc.  As  an  anodyne  and  emollient 
application,  glycerine  is  combined  with  morphine,  atropine, 
acetate  of  lead,  etc.,  etc.  To  form  ointments  and  embrocations, 
it  is  combined  with  gum  tragacanth,  lime  water,  oil  of  almonds, 
rose  water,  etc.,  etc. 


416 


DENTAL  MEDICINE, 


DENTAL    FORMULAE. 


For  Chronic  Abscess,    Ulcerations,  etc. 

R.    Glycerini 5J 

Tinct.  iodi.  comp.   .    .  TTt^'^v 
Acidi  carbolic!  cryst.  .  Tl^vj 
Aquae  destillatae  .    .    .  ^v.        M. 

SiGNA. — Apply   as   a  lotion   or   injec- 
tion. 


For  Inflammation  and   Ulceration  of 
the  Mucous  Membrane. 


For  Chronic  Alveolar  Abscess,  Ulcera- 
tion of  Mucous  Membrane,  etc. 

R.    Glycerini partem  i 

Acidi  tannici    .    .    .  partes    2 


For  Pulpitis. 


R. 


R.    Glycerini 5J 

Sodii   boratis    ,    .    .    .  ^ij. 
SiGNA. — Apply  as  a  lotion. 


M. 


Glycerini  .  .  . 
Acidi  carbolic! 
Tr.  aeon  it.  rad., 
Aq.  menth.  pip. 
Acidi  tannici  . 
01.  menth.  pip., 
01.   caryophilli 


.    .gtt.ij 
.    .  gr.v 

aa  gtt.ij 
•    •  gr-j 

aa  gtt.xxv.     M. 


For  Aphthous  Ulceration  of  the  Mouth, 

R.    Glycerini 3J 

Sodii  sulphitis  .    .    .    .  ^j 
SiGNA. — Apply  as  a  lotion. 


SiGNA. — Apply  on  cotton. 

For  a  Sedative  Application  in  Inflamed 

Mucous  Membrane. 
R .    Glycerini, 

Chloroformi     .    .  aa  Jss.  M. 

SiGNA. — Apply  as  a  lotion. 


For  Aphthous  Sore  Mouth  of  Infants.       t> 


R .    Glycerini, 

Aquae aa^ss 

Sodium  sulph gr.xxx.  M. 

SiGNA. — Use  on  swab,  every  2  hours. 


For  Pulp   Canals  of  Abscessed  Teeth. 
Faught. 
Glycerini  .... 
Acidi   tannici  .    . 
Morphise    acetatis 
Iodoform!      ►ij.        M. 


3'j 


Signa. — Apply  on  floss-silk  or  cotton 


GLYCOZONE. 

Derivation. — Glycozone  is  composed  of  chemically  pure 
glycerine  and  peroxide  of  hydrogen.  When  these  two  prep- 
arations are  combined,  the  result  is  a  stable  compound  owing  to 
the  reaction  that  takes  place  when  chemically  pure  glycerine  is 
submitted,  under  certain  conditions,  to  the  action  of  fifteen  times 
its  own  volume  of  ozone,  under  normal  atmospheric  pressure  at 
a  temperature  of  0°  C.  The  glycerine  thus  employed  must  be 
chemically  pure,  as  the  pressure  of  the  water  or  other  foreign 
matter  in  it  produces  in  the  resulting  compound  formic  acid, 
glyceric  acid,  and  other  secondary  products  that  have  an  injurious 
effect  on  animal  tissue.     Glycozone  possesses  a  pleasant,  sweetish 


GLYCOZONE.  4^7 


taste,  and  causes  a  feeling  of  warmth  when  it  conies  in  contact 
with  the  mouth  or  stomach. 

Medical  Properties  and  Action — Glycozone  excites  the  salivary- 
glands  to  increased  action  and  stimulates  the  gastric  secretions. 
It  attracts  to  itself  water  from  the  adjacent  tissues,  but  not  suffi- 
cient to  cause  injury,  a  property  due  to  the  glycerine  it  contains. 
In  excessive  doses  of  one  or  two  ounces,  glycozone  causes  epi- 
gastric uneasiness,  followed  by  loose,  copious,  watery  stools, 
which  are  accompanied  by  severe  cramps.  It  appears  to  have  no 
effect  upon  the  kidneys,  liver  or  heart.  It  is  slowly  decomposed 
in  the  stomach,  ozone  being  liberated  and  the  glycerine  uniting 
with  the  water  from  the  tissues.  It  is  supposed  that  the  morbid 
elements  with  which  it  comes  in  contact  hasten  this  decomposi- 
tion, and  in  so  doing  are  themselves  oxidized  and  destroyed. 
The  presence  of  free  ozone  in  the  stomach  resulting  from  the 
decomposition  of  glycozone  aids  the  digestive  process.  Glyco- 
zone must  be  kept  in  tightly-corked  bottles,  glass-stoppered  are 
best,  and  when  thus  protected,  it  will  not  deteriorate  at  a  tem- 
perature of  even  110°  F.  No  metallic  instruments  should  be 
brought  in  contact  with  it,  as  such  contact  decomposes  it ;  hence 
glass  or  hard-rubber  vessels  and  syringes  are  necessary  when 
using  it.  It  resembles  peroxide  of  hydrogen  in  producing  a 
powerful  oxidizing  effect,  although  its  action  may  not  be  as  rapid 
or  as  energetic  as  the  latter  compound ;  therefore  it  cannot  be 
safely  combined  with  other  drugs  or  chemical  substances  when 
prescribing  it. 

Therapeutic  Uses. — Glycozone  is  employed  in  the  treatment 
of  gastric  ulcer,  affections  of  the  stomach,  catarrh  of  chronic 
alcoholism,  chronic  gastric  catarrh  from  other  causes,  and  atonic 
and  acid  dyspepsia.  Externally — when  a  diseased  or  suppura- 
ting surface  is  cleansed  by  peroxide  of  hydrogen,  the  application 
of  glycozone  stimulates  healthy  action  and  promotes  recovery. 
It  also  checks  the  discharge  of  irritating  secretions,  and  prevents 
infection  from  pathogenic  organisms,  by  acting  as  a  powerful 
antiseptic  and  stimulant.  It  is  also  useful  in  follicular  pharyngi- 
tis, and  chronic  coryza,  and  croup. 

For  diphtheria  a  tablespoonful  of  glycozone  may  be  given  in 
27 


418  DENTAL  MEDICINE. 


a  wine-glassful  of  water  every  three  hours  with  excellent  effects  ; 
it  is  harmless.  For  membranous  croup,  after  spraying  the  nose, 
throat,  larynx  and  pharynx  copiously  every  two  hours  or  so  with 
a  mixture  of  peroxide  of  hydrogen  with  4  to  6  ounces  of  water, 
the  membranes  are  destroyed,  and  then  one  teaspoonful  of  gly- 
cozone,  diluted  in  a  wine-glass  of  water  and  given  three  times  a 
day,  will  prevent  any  disturbance  of  the  stomach,  and  will  regu- 
late the  bowels.  In  ulceration  and  chronic  inflammation  of  the 
intestines,  great  benefit  is  derived  from  enemata  consisting  of 
glycozone  5ji  and  lukewarm  water  .5xij,  prepared  just  before 
using;  also  in  fistula-in-ano  and  rectal  ulcerations  glycozone  oj 
and  lukewarm  water  5j,  administered  once  or  twice  daily,  will 
produce  good  results.  For  leucorrhcea,  the  vagina  is  first  washed 
with  peroxide  of  hydrogen  one  part  and  water  four  parts,  when 
glycozone  is  applied  on  small  rolls  of  lint,  or  absorbent  cotton, 
and  the  procedure  repeated  twice  daily. 

Dental  Uses. — Glycozone  is  employed  for  all  forms  of  inflam- 
mation and  ulceration  of  the  oral  mucous  membrane,  and  in 
ulcerative  stomatitis  frequent  applications  prove  very  beneficial. 
It  is  also  considered  to  be  useful  in  the  chronic  form  of  alveolar 
abscess  in  the  form  of  an  injection  composed  of  glycozone  and 
lukewarm  water. 

HAMAMELIS. 
WITCH   HAZEL. 

Source. — Hamamelis  Virginica  is  an  indigenous  shrub,  com- 
mon to  all  parts  of  the  United  States  and  Canada,  and  usually 
found  in  stony  places  and  on  the  banks  of  streams.  The  bark 
and  leaves  are  the  medicinal  portions. 

Medical  Properties  and  Action. — It  is  tonic,  astringent,  sedative, 
and  anodyne.  The  bark  has  a  bitter,  astringent,  and  somewhat 
sweetish  and  pungent  taste,  and  was  first  employed  by  the  In- 
dians as  a  sedative  and  discutient  application,  in  painful  tumors 
and  other  cases  of  superficial  inflammation.  The  bark  contains 
from  eight  to  ten  per  cent,  of  tannic  acid,  and  also  a  bitter  prin- 
ciple. 

Therapeutic  Uses. — Hamamelis   Virginica,   although    not   until 


MERCURY.  419 


recently  officinal,  has  for  some  time  been  employed  in  hemorrhage 
of  the  lungs,  haematemesis,  and  in  phthisis.  Externally,  it  is  ap- 
plied to  tumors,  inflamed  and  painful  parts,  etc.,  etc.,  in  the  form 
of  a  fluid  extract,  decoction  and  tincture.  Two  minims  of  the 
tincture  of  hamamelis  every  half  hour,  will  often  control  hemor- 
rhages from  nose,  uterus  and  from  hemorrhoids. 

Dose. — Of  the  fluid  extract  of  hamamelis,  5ss  to  oij  ;  of  the 
decoction  5ss  to  .5j. 

Dental  Uses. — Hamamelis  is  employed  in  dental  practice  as  a 
sedative  or  anodyne  application,  in  incipient  periodontitis,  in  the 
form  of  the  fluid  extract,  applied  warm  on  lint  or  cotton  as  a  lo- 
tion ;  also  as  an  anodyne,  to  irritated  and  painful  exposed  pulps 
of  teeth  ;  also  for  passive  hemorrhage  from  the  mucous  mem- 
brane of  the  mouth  ;  also  for  the  soreness  arising  from  the  re- 
moval and  effects  of  salivary  calculus.  The  tincture  may  be  ap- 
plied as  a  sedative  lotion,  in  the  proportion  of  one  part  to  ten  of 
water. 

HYDRARGYRUM— MERCURY. 
QUICKSILVER. 

Symbol. — Hg.     Sp.  gr.  13.5. 

Sources. — Mercury  is  a  metal  of  a  nearly  silver- white  color,  and 
a  very  high  degree  of  lustre.  It  is  liquid  at  all  ordinary  temper- 
atures, and  only  solidifies  when  cooled  to  39°  or  40°  F.  It  boils 
at  about  660°  F.,  it  is  malleable  at  40°  F.,  and  is  slightly  volatile 
at  60°  F.  ;  when  boiling  it  yields  a  transparent,  colorless  vapor, 
of  density  of  lOO.  It  also  volatilizes  somewhat  even  at  ordinary 
temperatures,  and  especially  above  68°  F.  The  ordinary  ore 
from  which  metallic  mercury  is  obtained  is  the  mercuric  sulphide^ 
although  it  is  occasionally  met  with  in  globules  disseminated 
through  this  native  sulphide.  There  is  also  a  form  known  as 
horn  silver^  or  native  calomel,  and  a  native  amalgam  of  silver  and 
mercury.  California  furnishes  metallic  mercury  of  a  peculiar 
purity,  in  large  quantities.  The  metal  is  obtained  from  the  sul- 
phide by  the  process  of  "  roasting."  When  pure,  metallic  mer- 
cury does  not  readily  tarnish  in  the  air,  and  has  neither  taste  nor 


420  DENTAL  MEDICINE. 


smell,  and  it  can  be  purified  by  re-distillation,  or  by  adding  to  it  a 
small  quantity  of  a  strong  solution  of  nitrate  of  mercury. 

The  impurities  are  generally  dirt,  dust,  lead,  tin,  bismuth  or 
zinc.  The  tarnishing  of  mercury  implies  the  presence  of  other 
metals. 

It  is  used  as  mercury  in  medicine  in  the  form  of  ointment, 
plaster,  gray  powder,  and  blue  mass.  All  preparations  of  mer- 
cury yield  to  absorption  and  after  absorption  to  elimination,  the 
rapidity  of  both  depending  to  a  great  extent  on  the  variety  of  it 
given.  According  to  Prof.  H.  C.  Wood,  a  single  dose  of  mer- 
cury does  not  remain  in  the  system,  but  when  the  drug  is  adminis- 
tered constantly  for  a  length  of  time,  the  elimination  does  not 
keep  pace  with  the  absorption,  so  that  the  mercury  accumulates 
in  the  tissues ;  also  that  the  elimination  is  irregular  and  inter- 
mittent, and  there  is  no  limit  of  time  during  which  the  accumu- 
lated mercury  may  remain  in  the  body,  and  that  all  probabilities 
point  to  the  possibility  of  mercury  being  deposited  in  the  tissues 
in  such  a  form  that  it  is  practically  inert  and  exerts  no  effect 
upon  the  system ;  it  is  liable  however,  under  certain  agencies,  to 
be  set  free  and  to  exert  its  power  upon  the  general  nutrition. 

Dental  Uses. — Metallic  mercury  is  employed  in  dental  practice 
as  an  ingredient  of  amalgam  filling  material,  being  combined  for 
such  a  purpose  with  silver,  tin  and  zinc,  and  sometimes  with  gold 
and  platinum,  in  addition  to  the  other  metals  named. 

Hydrargyri  Chloridum  Corrosivum. — Corrosive  Chloride 
of  Mercury — Corrosive  Sublimate.  Mercuric  Chloride^  Bichloride 
of  Mercury.     Formula.^  HgClg. 

Derivation. — Corrosive  sublimate  is  obtained  by  subliming  a 
mixture  of  chloride  of  sodium  and  mercuric  sulphate,  the  latter 
made  by  boiling  together  sulphuric  acid  and  mercury  ;  double  de- 
composition takes  places,  forming  mercuric  chloride  and  sulphate 
of  sodium.  Corrosive  sublimate  is  in  the  form  of  colorless  crys- 
tals, or  crystalline  masses,  which  are  inodorous,  fusible  and  sub- 
lime without  residue,  and  of  an  acrid,  styptic  taste.  It  is  readily 
soluble  in  15  parts  of  water,  7  parts  of  alcohol  and  ether. 

Medical  Properties  and  Action. — It  is  one  of  the  most  active 
salts  of  mercury,  and   is  a   corrosive   poison,  but  the    therapeutic 


MERCURY.  421 


dose  now  used  is  less  liable  to  cause  the  disagreeable  and  danger- 
ous effects  of  mercury  than  almost  any  other  preparation  em- 
ployed for  the  same  purposes.  It  is  in  the  form  of  colorless  crys- 
tals, and  is  entirely  soluble  in  water.  Corrosive  sublimate  is  an 
effective  germicide  in  the  strength  of  one  part  to  2500  parts  of 
water,  being  250  times  more  powerful  than  carbolic  acid.  An 
aqueous  solution  of  I  in  20,000  destroys  the  spores  of  bacilli  in 
ten  minutes,  and  a  solution  of  1-5000  is  a  certain  disinfectant, 
when  the  exposure  is  very  short,  and  it  is  now  regarded  as  one  of 
the  most  powerful  germicides  in  use  and  is  very  extensively  em- 
ployed in  antiseptic  surgery  ;  but  it  should  be  noted,  however, 
that  where  albumen  is  present  the  bichloride  is  decomposed  and 
rendered  inert.  The  same  occurs  when  solutions  are  permitted 
to  stand  for  some  time  even  when  distilled  water  is  used  as  a 
solvent.  The  addition  of  a  weak  acid,  tartaric,  or  chloride  of 
sodium,  will  prevent  such  decomposition.  The  bichloride,  ac- 
cording to  Koch,  is  efficacious  as  a  germicide  in  a  watery  solu- 
tion of  1—50,000. 

Dr.  F.  Abbott  regarded  the  bichloride  of  mercury  as  being  the 
simplest  antiseptic  in  use.  Dr.  W.  D.  Miller,  of  Berlin,  also 
testifies  to  the  power  of  the  bichloride  as  an  antiseptic  in  the 
treatment  of  the  oral  cavity  as  follows  :  "  The  experiments  show 
that  bichloride  of  mercury  is  about  two  hundred  times  as  power- 
ful as  carbolic  acid,  and  demonstrate  very  clearly  the  mistake  of 
substituting  weak  solutions  of  this  antiseptic  (i— 1000,  as  I  have 
seen  recommended)  for  concentrated  carbolic  acid.  One  one- 
thousandth  is  only  one-fifth  as  powerful  as  pure  carbolic  acid, 
which  in  many  cases  may  be  used  with  impunity.  It  is  conse- 
quently useless  to  attempt  to  introduce  the  sublimate  solution  for 
the  purpose  of  sterilizing  root-canals,  cavities  before  filling,  etc., 
unless  we  may  use  at  least  a  ^  per  cent.,  if  not  a  one  per  cent, 
solution.  I  see  no  reason  why  this  may  not  be  done.  In  a  few 
cases  I  have  used  a  i  per  cent,  solution  for  treating  root-canals, 
and  do  not  hesitate,  particularly  with  the  rubber  dam  adjusted,  to 
wipe  out  cavities  before  filling  with  a  two  per  cent  solution,  and 
see  no  possible  evil  which  would  result  from  it."  "  As  a  mouth 
wash  I  have  frequently  used  a  i   per  cent.  (i. 000)  solution  myself. 


422  DENTAL  MEDICINE. 


and  have  seen  no  bad  results  from  it ;  I  would  not,  however, 
recommend  it  to  my  patients  in  this  strength." 

The  solution  in  water,  i  part  to  2000,  will  approximate  i  grain 
to  41^  ounces  of  water. 

Dr.  Black  recommends  the  following  combination :  Mercuric 
chloride,  gr.  ij ;  peroxide  of  hydrogen,  fiSj.  M.  For  use  as  an 
injection  in  alveolar  abscess  and  the  pus  pockets  of  pyorrhoea 
alveolaris.  As  a  solution  of  bichloride  of  mercury  is  prone  to 
■undergo  chemical  changes,  powders  or  tablets  containing  equal 
quantities  of  the  bichloride  and  ammonium  chloride  may  be  pre- 
pared and  a  solution  made  by  adding  one  of  these  to  an  ounce  of 
distilled  water. 

Another  method  is  to  take  one  drachm  each  of  the  bichloride 
and  hydrochloric  acid,  and  add  enough  of  distilled  water  to  make 
one  ounce,  which  forms  a  permanent  solution,  strong  enough,  in 
the  proportion  of  a  teaspoonful  to  a  pint  of  water,  to  make  a  ster- 
ilizing and  disinfectant  solution  of  i  to  1000,  for  washing  out  pus 
sacs  and  pus  pockets  in  alveolar  abscess  and   alveolar  pyorrhoea. 

Referring  to  the  bichloride  of  mercury,  benzoic  and  salicylic 
acids  and  listerine.  Dr.  Miller  says  :  Of  these  four,  which  are 
available  for  the  prophylactic  treatment  of  the  oral  cavity,  partic- 
ularly of  the  teeth,  the  bichloride  is,  without  doubt,  the  most 
effective,  because  its  action  continues  longer;  and  he  further 
says :  "  Unfortunately  the  bichloride  of  mercury  possesses  one 
great  disadvantage  in  its  highly  poisonous  character.  It  seems, 
however,  scarcely  possible  that  any  harm  could  result  from  its  use 
in  so  dilute  a  form."     (See  Hydrargyri  Chloridum  Mite.) 

Passing  chlorine  through  an  alcoholic  solution  of  chloride  of 
mercury  will  prevent  the  decomposition  of  the  latter  when  ex- 
posed to  light,  or  any  change,  by  loss  of  chlorine,  to  mercurous 
chloride. 

Therapeutic  Uses. — Corrosive  sublimate  is  alterative  in  small 
doses,  and  in  large  quantities  it  is  a  powerful  irritant  poison,  cor- 
roding the  stomach  and  causing  death  in  a  very  few  hours.  Its 
continued  use  has  caused  salivation,  but  it  has  a  less  tendency  to 
produce  such  an  effect  than  the  other  preparations  of  mercury. 
Internally  it  is  employed  in  secondary  syphilis,  chronic  diarrhoea 


MERCURY.  423 


and  dysentery.  Externally  in  diseases  of  the  eye,  diseases  of  the 
skin,  ulcers,  gonorrhoea  and  gleet,  etc.,  etc.  The  external  appli- 
cation to  large  surfaces  is  dangerous.  Its  use  is  contra-indicated  in 
patients  affected  with  pulmonary  disease.  Drs.  Yates  and  Kings- 
ford  report  three  cases  of  cancrum  oris  in  children  cured  by  wip- 
ing the  affected  parts  with  a  solution  of  the  bichloride  of  mercury 
(i  to  500),  and  afterwards  dressing  them  with  lint  soaked  in  a 
similar  solution  (i  to  1000).  He.althy  granulations  soon  made 
their  appearance,  and  the  wound  quickly  contracted. 

For  cases  of  poisoning  the  antidotes  are  albumen,  white  of  egg, 
wheat  flour,  milk,  etc. 

Dose. — Of  corrosive  sublimate  gr.  ^^  to  gr.  ^i^j,  in  pill  or  solu- 
tion. 

Dental  Uses. — In  addition  to  what  has  already  been  stated  in 
regard  to  the  dental  uses  of  bichloride  of  mercury,  it  is  employed 
as  a  lotion,  injection  or  gargle,  in  chronic  diseases  of  the  mucous 
membrane,  ulcers,  ulitis,  etc.  Dr.  C.  T.  Stockwell  reports  a  case 
of  acute  ulitis  in  which  bichloride  of  mercury,  in  solution  i-iooo, 
was  used  to  bathe  the  parts,  and  the  pockets  about  the  teeth  in- 
jected with  it,  the  result  being  very  satisfactory  ;  and  the  same 
solution  used  as  a  sterilizing  agent  is  considered  to  be  very  effi- 
cient. For  sterilizing  cavities  and  root-canals  of  the  teeth  it  is  a 
valuable  and  efficient  antiseptic  and  germicide ;  also  weak  solu- 
tions are  useful  for  treating  abscess,  ulcers.  When  used  as  a 
sterilizing  agent,  the  rubber-dam  should  be  adjusted  previous  to 
its  application. 

Test  for  Bichloride  of  Mercury. — Dr.  Chas.  Mayr  recommends 
the  following  to  determine  whether  a  solution  of  bichloride  of 
mercury  is  still  reliable  or  not:  Saturate  a  nice  grade  of  paper 
with  a  solution  of  a  given  amount  of  iodide  of  potassium  in  water; 
with  the  proper  gauging  of  this  solution,  after  it  has  dried  on  the 
paper,  a  drop  of  the  solution  of  the  bichloride  (i  to  500)  will  pro- 
duce a  scarlet  spot  when  dropped  on  the  paper ;  a  solution  of  i 
to  1000,  a  yellow  spot ;  a  more  dilute  solution,  no  spot  at  all. 
To  obtain  this  result,  a  certain  strength  of  the  solution  of  iodide 
of  potash  guaged  for  the  paper  to  be  used  is  required.  The  solu- 
tion of  iodide  of  potash  should  be  made   slightly   alkaline,  which 


424 


DENTAL  MEDICINE. 


will  prevent,  to  a  great  extent,  the  paper  from  turning  blue. 
Diluting  a  solution  of  bichloride  of  mercury  with  lime  water  will 
remove  the  disagreeable  taste. 


DENTAL    FORMULA. 
J^or  Chronic  Alveolar  Pyorrhea.  Antiseptic  and  Stimulant  Alouth  Wash, 

Dr.  a.  W.  Harlan.  (^""^  "'^  especially  in  Alveolar  Pyor- 

rhcEa.) 
B .  Hydrarg.  bichlor.  .    .    .  grs.ij       •  Dr.  Chas.  B.  Atkinson. 

Acidi  tartarici    .    .    .    .  grs.x  ^     Hydrarg.  bichlor.      .    .  gr.ij 

Aquae  destillatae   .    .    .  f g  iv.    M.  Tinct.  calendulcC.  .    .    .  3  iv 

Aquse  dest.  q.  s.;  ad.     .  g  viij.  M. 
SiGNA. — First  cleanse  with  injections       c,f,.,»      tt     a    1 
of  peroxide  of  hydrogen,  and  then 

inject  the  above  with  a  hypodermic       .7.      r>-.r.      f  r.      j    rs     ^^ 
•" .  -"^  Jo     Visinject     ito/tened   Dentine    in 

■'       ^  '  Cavities. 

'  Dr.  a.  W.  Harlan. 

Antiseptic  Solution.  B-     Hydrarg.  bicl.lor.     .    .  gr.ij. 

Hydrogen  perox.    .    .  gj 

Emil  Rotter.  Acidi    tartarici    .    .    .  ITlv.      M. 

R .    Corrosive  sublimate,  I  to  Aqueous  solutions  of  Labarraque's 

20,000                          gr.j  solution,   permanganate    of  potash    or 

Sodii  chlorid gr.vss  boro-glycerine,  may  also  answer. 

Acid,  carbolic  .    .    .    .  gr.xxx  P'of-  W.   D.  Miller,  of  Berlin,  in  a 

Zinci  chlorid.  ^^^*  °^  remedies  with  which  he  made 

Zinci  carbolat.             aii  X\\i  careful  experiments,  places  the  relative 

Acid  boric                     gr.xl  powers  of  well-known  agents  in  pre- 

Acid  salicylic                gr.x  venting   the  development  of  fungi  as 

Thymoli Tttij  follows : 

Acid,  citnc gr.ij  Bichloride   of    mercury  .    .  1-100,000 

Aquse.    .    .  q.  s.  ad.  1,000.00.    M.  Peroxide   of    hydrogen.    .1-50,000 

Iodine i-     6,000 

Said  to  be  powerful,  yet  not  toxic  to       Iodoform i-      5,000 

any  dangerous  extent,  and  to  have  a       Salicylic  acid i-      2,000 

more  potent  effect    on  pyrogenic    mi-       Eucalyptus i-      1,600 

crobes  than  sublimate  in  solutions  of  i       Carbolic  acid       i-       1,500 

to  1000.     If  a  weak  solution  is  desired       Chloride  of  zinc i-      1,250 

the  sublimate  and  carbolic  acid  may  be  Permanganate  of  potash     .  i-      1,000 

omitted.  Listerine    .    .   • i-         120 

Hydrargyri  Chloridum   Mite — Mild  Chloride  of  Mercury. 
Calomel.     Mercurous  Chloride.      Formula. — HgCl. 

Derivation. — Calomel  is  obtained  by  subliming  a  mixture  of 


MERCURY. 


425 


mercurous  sulphate  and  chloride  of  sodium,  a  double  decomposi- 
tion taking  place,  by  which  mercurous  chloride  and  sulphate  of 
sodium  are  formed.  The  mercurous  sulphate  thus  employed  is 
obtained  by  boiling  mercury  in  sulphuric  acid  and  triturating 
the  resulting  mercuric  sulphate  with  mercury. 

To  remove  any  corrosive  sublimate  which  the  calomel  may 
contain,  it  is  washed  with  hot  distilled  water  until  the  absence  of 
a  white  precipitate  with  ammonia  shows  that  the  poisonous  in- 
gredient has  been  removed.  Calomel  is  in  the  form  of  a  white, 
inodorous,  tasteless  powder,  insoluble  in  water,  alcohol  and  ether, 
and  wholly  volatilized  by  heat.  Calomel  is  incompatible  with 
the  alkalies,  and  alkaline  earths,  and  alkaline  carbonates,  with  lead, 
copper  and  iron.  When  nitro-muriatic  acid  is  combined  with  it, 
corrosive  sublimate  is  formed  ;  neither  should  it  be  given  in  com- 
bination with  iodine. 

Medical  Properties  and  Action. — Calomel  and  the  other  mercurials 
are  employed  as  alteratives,  sialagogues,  purgatives,  diuretics,  etc., 
and  moderate  doses  increase  the  action  of  the  secreting  glands 
and  organs,  stimulating  the  salivary  glands  in  a  very  decided  man- 
ner. When  large  doses  are  administered  the  effects  are  manifested 
on  the  gums,  which  become  tender  and  swollen,  the  salivary 
glands  take  on  increased  action,  the  saliva  and  buccal  mucus  flow 
profusely,  the  mucous  membrane  of  the  mouth  becomes  inflamed 
and  ulcerated,  the  tongue  swollen  and  the  breath  fetid,  with  a 
metallic,  copper  taste,  and  the  teeth  become  loose  ;  such  symp- 
toms constitute  the  condition  known  as  salivation.  When  the 
use  of  the  drug  is  discontinued  these  symptoms  disappear,  but  the 
mucous  membrane  and  gums  are  ever  after  more  susceptible  to 
irritation,  and  the  stability  of  the  teeth  is  more  or  less  impaired, 
as  is  shown  by  the  recession  of  the  gums  and  the  absorption  of 
the  alveolar  processes.  In  many  cases  the  gums,  especially  about 
the  necks  of  the  teeth,  remain  somewhat  tumefied,  with  a 
tendency  to  ulceration. 

If  the  use  of  the  mercury  is  continued  beyond  the  stage  which 
the  symptoms  just  described  indicate,  or  even  as  the  effects  of 
small  doses  in  persons  very  susceptible  to  the  influence  ot  mer- 
cury,  an    excessive  salivation   ensues,  with  serious  ulceration  of 


426  DENTAL  MEDICINE. 


the  gums  and  mucous  membrane  of  the  mouth,  loss  of  the  teeth, 
and  even  necrosis  of  the  bones  of  the  jaws.  Mercury  has  also 
the  effect  of  causing  considerable  emaciation,  from  the  absorption 
of  fat,  and  sometimes  a  peculiar  febrile  state  known  as  mercurial 
fever ;  and  also  diarrhoea,  skin  diseases,  rheumatism,  neuralgia  and 
disorder  of  nervous  system.  Mercury,  after  it  is  absorbed,  has  a 
decided  effect  upon  the  blood,  which  it  impoverishes,  destroving 
the  red  blood  globules  (hematine  and  globuline) ;  the  blood  con- 
tains more  water,  is  more  prone  to  putrefaction,  and  the  unnatural 
fluidity  predisposes  to  hemorrhage,  which  may  become  dangerous. 

Therapeutic  Uses. — Mercury  in  the  form  of  calomel,  blue  mass 
(Pilule  Hydrargyri — pills  of  mercury — mercury  .^ij  ;  confection 
of  rose  Siij,  and  powdered  liquorice  root  gj),  are  employed  as 
alteratives,  sialagogues,  indirect  tonics  and  cholagogues,  and  pur- 
gatives in  syphilis,  diseases  of  the  skin,  bilious  derangements, 
dyspepsia,  acute  glandular  affections,  diarrhoea  and  dysentery  of 
infants,  hepatic  disorders,  croup  and  membranous  laryngitis, 
cholera,  etc.,  etc. 

Dose. — Of  calomel,  gr.  tV  to  gr.  x ;  of  blue  pills,  or  mass, 
gr.  ss  to  gr.  XV.  Mercurials  are  administered  by  the  mouth,  by 
inunction,  by  fumigation,  and  by  the  hypodermic  method. 

Mercurial  Ointment — Unguentum  Hydrargyri.  Blue  oint- 
ment is  made  by  rubbing  two  parts  of  mercury  with  one  part  of 
suet  and  lard  each,  until  the  globules  disappear.  When  rubbed 
into  the  skin,  it  produces  the  constitutional  effects  of  mercury, 
and  is  applied  to  tumors,  syphilitic  sores,  blistered  surfaces,  and 
is  used  to  destroy  pediculi,  and  also  to  prevent  pitting  in  small- 
pox. 

Mercury  with  Chalk. — Hydrargyrum  cum  Creta^  a  gray 
powder,  consists  of  mercury,  three  parts,  prepared  chalk,  five 
parts.  It  is  a  gentle  laxative,  when  given  in  full  doses,  and  is 
antacid,  and  employed  chiefly  as  an  alterative  in  infantile 
diarrhoea,  etc. 

Dose. — Of  mercury  with  chalk,  for  adults,  gr.  v  to  xx ;  for 
children,  gr.  ss  to  ij,  iij  or  x. 

The  effect  of  mercurial  preparations  upon  children  is  some- 
times very  serious,  as  a  profuse,  or  even  gentle  salivation  will, 


MERCURY. 


427 


at  times,  cause  mortification  and  destruction  of  the  bones  of  the 
jaw,  the  teeth,  the  cheek  and  lip  j  and  although  such  cases  may 
not  be  common,  yet,  to  avoid  such  a  powerful  action,  the  gums 
should  be  frequently  and  carefully  examined,  when  a  course  of 
such  remedies  is  being  pursued. 

Protiodide  of  Mercury — Hydrargyrum  lodidum  Viride 
known  also  as  Green  Iodide  of  Mercury — is  prepared  by  rubbing 
mercury  and  iodine  together  with  the  addition  of  a  little  alcohol. 
The  formula  is  Hgl,  and  it  is  in  the  form  of  a  greenish-yellow 
powder,  insoluble  in  water  and  alcohol,  but  soluble  in  ether. 
Exposure  to  the  light  partially  decomposes  it,  when  it  becomes 
of  a  dark  olive  color. 

Protiodide  of  mercury  is  internally  administered  in  scrofula  and 
scrofulous  syphilis.  It  exercises  a  specific  influence  over  the 
lymphatic  and  glandular  system.  It  should  never  be  given  at 
the  same  time  as  iodide  of  potassium,  as  it  converts  it  into  bin- 
iodide  and  metallic  mercury. 

Doie. — Gr.  I  to  j. 

Externally,  protiodide  of  mercury  is  applied,  in  the  form  of 
ointment,  to  syphilitic  ulcers,  acne,  pityriasis,  etc.,  etc. 

BiNiODiDE  OF  Mercury — Hydrargyri  lodidum  Rubrum. — Red 
Iodide  of  Mercury.  Mercuric  Iodide.  A  red  powder  which 
becomes  yellow  when  heated  and  red  again  when  cold.  It  is 
wholly  volatilized  by  heat,  and  condenses  in  scales,  which  are 
first  yellow,  but  afterwards  red.  It  is  insoluble  in  water,  but  sol- 
uble in  boiling  alcohol  and  solutions  of  iodide  of  potassium  and 
chloride  of  sodium.     Poisonous. 

Dose. — Gr.  jj  to  ^ig.     It  is  a  powerful  germicide. 

Red  Sulphuret  of  Mercury — Hydrargyri  Sulphidum  Ru- 
brum.— Vermilion.  Cinnabar.  In  brilliant  crystalline  masses  of 
a  deep-red  color  and  fibrous  texture.  It  is  entirely  volatilized 
by  heat.  It  is  not  soluble  in  either  nitric  or  muriatic  acid,  but  a 
mixture  of  the  two  acids  will  dissolve  it.  Cases  have  been  cited 
in  support  of  the  asserted  poisonous  eff^ects  of  vermilion,  where  it 
has  been  used  as  a  coloring  matter  for  dental  vulcanite,  but  a 
careful  analysis  as  well  as  evidence  based  upon  scientific  investi- 
gation, fails  to  establish   the   truth  of  such  a  theory.     Vulcanite 


428  DENTAL  MEDICINE. 


composed  only  of  pure  caoutchouc  and  sulphur,  known  as 
*'  black  vulcanite,"  possesses  advantages  over  the  red  vulcanite, 
in  being  of  finer  texture,  more  dense,  and  less  spongy,  and  con- 
sequently less  liable  to  absorb  and  retain  the  secretions  of  the 
mouth,  in  the  case  of  an  artificial  denture  constructed  of  it. 

DENTAL  FORMULAE. 

For  Diarrhcea  of  Dentition.  For  Venereal  Sore  Mouth  and  Throat. 

R .     Calomel gr.ij  ad  vj  R .     Hydrar.  chlor.  corrosi   gr.j 

Cretseppt gr.xviij  Mellis  despuniati    .    .  f5ss 

Ipecacuanhae  pulv.   .  gr.ij  Aqure  destillatse  .    .    .  f  ^5  iv.    M. 

Extract  hyoscyami    .  gr.iij  ad  vj.  Signa. — To  be  used  as  a  gargle. 
F.  chart,  No.  vj. 

Signa. — One  every  2  or  3  hours  ac-  For  Warts,  Condylomata,  etc. 

cording  to  circumstances.  j^.     Hydrar.  chlor.  corrosi     ^j 

Collodii ^j.  Solve. 

For  Febrile  Excitement  of  Dentition.  SiGNA.— To   be    applied  as  a  caustic, 

R .     Calomel gr.ij  ad  iij  with  a  camel's-hair  brush. 

Magnes,  calc.    .    .    .  gr.xxiv 

Ipecacuanhse   pulv.  .  gr.ij  to  iij  For  Diarrhcea  of  Teething  Children. 

F.  ch.  No.  xij.  jj       Hydrargyri  cum  cretse, 

Signa.— One    to    be    given  every   3  Puiv.  ipecac  et  opii  .  aa  gr.j.     M. 

hours.  Signa. — One  powder. 

lATROL. 

Derivation. — latrol  is  obtained  by  a  synthetical  process  from 
certain  coal-tar  derivatives,  and  possesses  the  combined  properties 
of  iodine,  phenol  and  methylsalicylic  acid. 

Physical  Properties. — latrol  is  an  impalpable  white  powder,  with- 
out odor,  slightly  astringent,  of  acrid  taste,  non-toxic,  non-irritant, 
stainless ;  unaffected  by  ordinary  conditions  of  light  and  heat, 
and  does  not  decompose  under  the  action  of  metallic  oxides,  salts 
of  mercury,  or  alkalies.  It  is  readily  soluble  in  alcohol,  ether 
and  chloroform  ;  but  insoluble  in  cold  water,  glycerine,  the  fixed 
oils  and  vaseline.  It  is  slightly  soluble  in  warm  water.  It  may, 
however,  be  incorporated  with  the  insolubles  mentioned,  in  the 
form  of  ointments,  suppositories,  etc. 

Medical  Properties  and  Action. — latrol  is  antiseptic,  aseptic, 
astringent,  antizymotic,  germicide,  cicatrizant  and  parasiticide  ; 
also,   slightly   anaesthetic   (local).     Internally,   iatrol   is  antiseptic 


IODOFORM.  429 


and  possesses  slight  analgesic  and  antipyretic  action.  Externally 
it  is  applied  in  the  form  of  a  dry  dusting  powder,  and  promotes 
rapid  healing  of  incised  and  lacerated  wounds,  burns  and  ulcers. 
It  is  also  employed  by  insufflation,  in  catarrhal  conditions  of  the 
ear,  nose,  and  throat.  It  is  also  used  in  chancres,  chancroids  and 
mucous  patches  with  advantage.  Internally  iatrol  is  employed 
for  fermentative  conditions  of  the  alimentary  canal. 

Dose, — Internally,  gr.  j  to  ij,  either  alone  or  combined  with 
nux  vomica,  bismuth,  or  podophyllin. 

Dental  Uses. — Iatrol  is  employed  as  an  antiseptic  and  germicide 
in  all  pathological  conditions  of  the  oral  cavity  where  iodoform, 
iodol,  aristol,  etc.,  may  be  indicated.  It  is  also  incorporated  in  a 
dentifrice  with  satisfactory  results.  For  mucous  patches  and 
ulcers  of  the  mouth  it  possesses  advantages  over  many  other  an- 
tiseptic and  germicidal  agents  in  being  non-toxic,  non-irritant, 
and  odorless. 

lODOFORMUM— IODOFORM. 
TERIODIDE    OF    FORMYL. 

Formula. — CHI3. 

Derivation. — Iodoform  is  a  preparation  of  iodine,  being  ob- 
tained by  the  action  of  chlorinated  lime  upon  an  alcoholic  solu- 
tion of  iodide  of  potassium,  heated  at  104°  F.,  the  product  being 
iodoform  and  iodate  of  lime,  the  iodoform  being  separated  by 
boiling  alcohol.  It  is  in  the  form  of  small,  pearly  crystals,  of  a 
yellow  color,  with  an  unpleasant  odor,  like  that  of  saffron,  and  a 
sweetish  taste,  and  soft  to  the  touch.  It  is  volatile,  and  soluble 
in  alcohol,  chloroform,  ether  and  the  fixed  and  volatile  oils,  but 
insoluble  in  water. 

Medical  Properties  and  Physiological  Action. — Iodoform  has  no 
irritant  action,  and,  in  small  doses  is  tonic,  stimulant,  anodyne, 
alterative  and  disinfectant,  having  great  influence  on  the  nervous 
system  -,  it  is  also  antiseptic,  but  is  not  a  germicide,  and  although 
its  germicidal  action  is  practically  nothing,  it  is  extensively  used 
in  surgical  practice.  Its  good  effects  upon  the  tissues  of  wounds 
are  due  to  its  protecting  power  both  mechanically  and  by  the  dry- 
ness  it  maintains,  when    it  is   applied    in  the  form  of  a  powder. 


430  DENTAL  MEDICINE. 


Although  it  will  not  destroy  micro-organisms,  yet  it  will  destroy 
the  toxic  substances  formed  by  micro-organisms.  In  large  doses, 
it  causes  a  form  of  intoxication,  followed  by  convulsions  and  fatal 
effects.  In  the  form  of  vapor,  it  possesses  anaesthetic  properties, 
but  not  equal  to  those  of  the  general  anaesthetics  in  common  use. 
It  has  also  been  used  as  a  local  anaesthetic,  and  also  as  an  anti- 
septic. Its  odor  can  be  detected  in  the  blood,  the  brain  and  the 
muscles. 

Therapeutic  Uses. — Iodoform  produces  the  constitutional  effects 
of  iodine,  but  is  chiefly  used  externally  for  painful  cancerous  and 
phagedenic  ulcerations,  irritable  ulcers,  ill-conditioned  wounds, 
obstinate  skin  diseases,  scrofulous  glandular  enlargements,  to  allay 
the  pain  of  gout  and  neuralgia,  and  for  phthisis,  mixed  with 
starch  and  spread  on  paper,  so  that  the  vapor  may  be  inhaled. 
Dusted  over  a  diseased  surface,  it  allays  pain  and  changes  the 
morbid  action.  A  saturated  solution  of  iodoform  in  chloroform 
is  recommended  for  neuralgia ;  also  a  saturated  solution  in  any  of 
the  essential  oils  is  used  for  the  same  affection.  In  the  form  of 
an  ointment,  it  is  used  as  an  application  to  irritable  ulcers.  For 
ulcerated  surfaces,  it  may  be  sprinkled  over  the  part,  and  lint, 
coated  with  glycerine,  applied  as  a  dressing. 

Dose. — Of  iodoform,  gr.  j  to  gr.  iij,  three  times  a  day,  in  the 
form  of  a  pill. 

Dental  Uses. — Iodoform  is  highly  recommended  in  dental  prac- 
tice not  only  as  an  antiseptic  but  as  an  anaesthetic,  either  alone, 
or  what  is  better,  combined  with  eucalyptus  oil.  It  possesses  no 
escharotic  property  sufficient  to  cause  irritation  or  the  destruction 
of  parts.  In  the  treatment  of  alveolar  abscess,  iodoform,  in  com- 
bination with  oil  of  eucalyptus,  has  given  great  satisfaction ;  also 
in  cases  of  putrescent  pulps  applied  as  an  injection.  It  is  recom- 
mended to  be  used  as  follows :  First,  an  injection  of  eucalyptus 
oil,  followed  by  the  introduction  of  the  mixture  of  iodoform  and 
eucalyptus  into  the  root  canal,  on  cotton,  or  on  a  strand  of  floss- 
silk,  which  is  charged  by  first  dipping  it  into  the  oil,  and  then 
into  the  iodoform  ;  or  the  two  may  be  combined  in  a  solution 
(see  Eucalyptus),  and  in  this  form  introduced  into  the  sac  or  root 
canal.      Dr.  C.  N.  Peirce  recommends  iodoform  ground  up  with 


IODOFORM.  431 


equal  parts  of  oil  of  cloves  and  oil  of  eucalyptus,  which  forms  a 
substance  of  a  soft  cheesy  consistence,  a  portion  of  which  can  be 
introduced  to  the  inflamed  part,  on  the  point  of  a  small  broach. 
Iodoform  is  also  a  very  serviceable  application  in  alveolar  pyor- 
rhoea. A  saturated  solution  in  eucalyptus  oil  is  also  serviceable 
as  an  external  application  in  neuralgia.  Iodoform  is  also  em- 
ployed as  an  anodyne,  for  the  relief  of  the  pain  following  the  ex- 
traction of  teeth  affected  with  periodontitis,  and  alveolar  abscess  ; 
also  as  an  injection  in  diseases  of  the  antrum,  and  as  a  packing 
for  the  pus  pockets  in  alveolar  pyrrhoea,  for  which  purpose  it  is 
often  combined  with  oil  of  eucalyptus,  or  oil  of  cinnamon.  Also 
for  filling  the  canals  of  pulpless  teeth,  for  which  purpose  a  paste 
of  iodoform  and  carbolic  acid  is  used,  and  allowed  to  remain  for 
a  few  days,  and,  if  no  soreness  follows,  a  permanent  root-filling 
can  then  be  introduced.  When  iodoform  is  used  alone,  a  pellet 
of  cotton  or  a  strand  of  floss-silk  may  be  dipped  into  glycerine, 
and  the  iodoform  be  thus  taken  up.  Dr.  Francis  Peabody  rec- 
ommended the  application  of  the  vapor  of  crystals  of  non-agglu- 
tinized  iodoform  for  treating  pulpless  and  diseased  teeth,  blind 
abscesses,  etc.  The  cylinder  of  a  hot-air  syringe  is  partly  filled 
with  the  crystals,  and  heated  over  an  alcohol  flame  or  gas  jet  un- 
til the  crystals  are  fused.  The  syringe  point  is  then  placed  in 
the  root  and  the  bulb  compressed,  forcing  the  vapor  of  iodoform 
into  the  canal,  every  part  of  which  it  permeates,  the  tubili  being 
filled  throughout,  and  a  precipitate  deposited,  forming  a  solid,  in- 
soluble filling.  The  vapor  penetrates  the  apical  foramen  and 
comes  in  contact  with  the  peridental  membrane  subduing  irrita- 
tion and  inflammation,  gradually  restoring  the  tooth,  and  if  loose, 
rendering  it  firm  in  its  aveolus.  To  disguise  the  unpleasant  odor 
of  iodoform,  it  may  be  incorporated  with  a  little  oil  of  rose,  as 
one  drop  of  the  oil  will  remove  the  odor  of  half  a  drachm  of 
iodoform  ;  the  odor  is  also  disguised  by  balsam  of  Peru,  oil  of 
cinnamon,  oil  of  lavender,  or  oil  of  sassafras.  Three  grains  of 
cumurin  (a  derivative  of  the  Tonka  bean)  will  disguise  the  odor 
of  one  drachm  of  iodoform;  or  the  addition  of  attar  of  rose,  one 
minim  to  the  drachm  ;  or  of  essence  of  rose  geranium,  three  or  four 
minims  to  the  drachm.      Creolin  is  also  a  very  good  deodorizer  of 


432  DENTAL  MEDICINE. 


iodoform ;  also  aqua  heliotrope,  for  the  hands  also,  one  or  two 
drops  of  creasote  or  carbolic  acid  to  the  ounce  of  iodoform,  is 
also  recommended.  According  to  some,  it  is  not  a  matter  of  in- 
difference whether  iodoform  be  applied  as  a  dressing  for  wounds 
and  ulcers,  in  the  form  of  crystals,  as  amorphous  powder  dis- 
solved in  ether  or  as  an  ointment.  Iodoform  acts  not  only  as  a 
chemical  combination,  allowing  the  escape  of  iodine  in  a  free 
state,  but  it  has  certain  mechanical  properties.  When  the  sur- 
face of  an  ulcer  or  wound  is  covered  with  a  layer  of  iodoform  in 
crystals,  a  certain  degree  of  absorption  of  the  fluids  secreted  takes 
place.  These  products  of  secretion  penetrating  the  interstices 
between  the  minute  crystals  of  iodoform  soon  lose  the  liquid 
form,  and  produce  with  them  an  impermeable  crust.  Under  this 
crust  cicatrization  soon  occurs,  without  any  retraction  of  the 
tissues ;  hence  they  suppose  that  the  best  form  in  which  to  em- 
ploy iodoform  for  ulcers  and  wounds  is  that  of  the  crystals.  As 
toxic  effects  have  followed  the  internal  administration  of  iodo- 
form, it  should  be  prescribed  with  care,  and  also  the  application 
of  it  to  extensive  surfaces  should  be  avoided.  The  toxic  symp- 
toms have  been  manifested  as  follows,  the  maximum  dose  which 
caused  them  in  a  certain  case  being  iij/^  grains: 

"  Giddiness,  vomiting  arid  deep  sleep,  from  which  the  patient 
could  be  roused  with  difficulty.  The  somnolence  was  interrupted 
by  periods  of  excitement,  each  lasting  several  hours,  and  was  fol- 
lowed by  delirium,  intense  headache,  sense  of  impending  death, 
spasmodic  contractions  of  the  facial  muscles,  and  in  the  case  of 
the  younger  patient,  diplopia.  The  functions  of  the  other  sen- 
sory organs  were  not  disturbed,  and  the  pupils  presented  a  nor- 
mal reaction.  Deep  inspirations  alternated  with  apncea  of  about 
a  minute's  duration.  After  five  or  six  days,  the  toxic  symptoms 
gradually  lessened  and  passed  away." 

Iodoform  has  been  used  for  odontalgia,  on  account  of  its  gently 
caustic  and  anodyne  reaction  on  exposed  pulps  of  teeth.  Com- 
bined with  arsenious  acid  and  creasote  in  a  devitalizing  mixture, 
iodoform  lessens  the  pain  caused  by  the  arsenical  paste.  Dr. 
James  Truman  was  the  first  to  suggest  the  use  of  iodoform  in 
combination  with  arsenious  oxide. 


IODOFORM. 


433 


M.  Rummo,  of  the  Academy  of  Science,  regards  iodoform  as 
exerting  an  anaesthetic  action  when  applied  to  wounds,  but  with- 
out the  power  to  destroy  germs  in  putrescent  matter,  although  it 
prevents  their  development.  M.  Sauvat  says  that  iodoform,  when 
applied  to  wounds,  reduces  effusion  and  favors  cicatrization,  and 
exerts  an  anaesthetic  action  ;  but  if  carelessly  used  it  may  cause 
erythema  or  even  erysipelas.  Iodoform  in  powder  is  now  a  pop- 
ular dressing  for  wounds.  Iodoform  is  more  easily  dissolved  in 
alcohol  and  ether  if  there  is  camphor  already  dissolved  in  them  ; 
as  an  example  :  alcohol  will  dissolve  only  1 1^  per  cent,  of  iodo- 
form, while  a  saturated  solution  of  camphor  will  dissolve  lO  per 
cent.  The  spirits  of  turpentine  will  remove  the  odor  of  iodo- 
form from  the  hands. 


DENTAL    FORMULAE. 


New  Methods  for  Deodorizing 
Iodoform. 

I. — Carbolic  acid    .    .    .  i  part 

Iodoform 2  parts. 

Powder  and  mix  well. 
No  change  appears  to  take  place  in 
the  iodoform,  but  the  odor  is  masked 
by  that  of  carbolic  acid. 
2. — Iodoform    .        ...  lOO  parts 
Oil  of  peppermint  5  parts 

Oil  of  neroli  ....  i  part 
Oil  of  lemon  ....  2  parts 
Tinct.  benzoin  .    ,  2  parts 

Acetic  acid  ....  i  part. 
Powder  the  iodoform,  and  mix  thor- 
oughly with  the  other  ingredients. 
Transfer  to  a  well-stopped  flask,  and 
keep  at  a  temperature  of  from  120O  F. 
to  140°  F.,  over  a  water  bath,  for  2 
days.  The  mixture  has  a  pleasant  odor 
of  Eau  de  cologne. 

3. — Camphor 5  parts 

Charcoal    .    .        .    .  10  parts 

Iodoform 15  parts. 

Powder  and  mix  intimately. 
28 


For  Pulpless  Teeth. 

R .    lodoformi gr.x 

Acidi  tannic!     .    .    .  gr.iij 
Glycerini       ....  gtt.xv.        M. 
SiGNA. — Apply    on    floss-silk,    or    by 
syringe. 

Preparation.— Rub  iodoform  to  fine 
powder,  in  a  mortar,  and  add  the 
tannin,  and  after  mixing  thoroughly, 
add  the  glycerin.  One  drop  of  oil  of 
cinnamon  will  disguise  the  odor. 

For  Devitalizing  Pulps  of  Teeth. 

R.    lodoformi gr.v 

Acidi  arsenios  .    .    .  gr.x 

Creasoti q.s.  M. 

To  make  a  paste. 
SiGNA. — Apply  on  cotton,  or  on  point 
of  a  broach. 

For  Putrid  Pulps. 
A.  P.  Johnson. 
R.    lodoformi  ....      gr-j's 
Camphors    ....  3  ^ 

Alcoholis ^j 

Mix   by  dissolving  the  camphor    in 


43i 


DENTAL  MEDICINE. 


the   alcohol,  and   then   add  the  iodo- 
form. 

SiGNA. — Use  as  an  injection. 

As  a  capping  for  an  exposed  pulp,  it 
is  suggested  to  dissolve  the  fillings  of 
celluloid  in  the  above  mixture  and 
form  a  thick  paste. 


R. 


For  Odontalgia. 
SCHAFF. 
Pulv.  iodoformi    .    .  gr.lx 


Kaolin gr.lx 

Acidi  carbolici  .    .    .  gr.viij 

Glycerini q.s. 

Olei  menthae  piperit .  gtt.x 
Triturate  the  iodoform,  kaolin,  and 
oil  of  peppermint,   with  enough   gly- 
cerine to  form  a  thick  paste. 
SiGNA. — Apply  to  exposed  surface  of 
pulp. 

For  Pulpless  Teeth  with  a  Fistulous 
Dr.  Opening. 
Faught. 
R .    Iodoformi 
Acidi  tannic! 
Glycerini 
Morphinse  acetat.     .  ^\.  M. 


•  9J 

•  3J- 


SiGNA Apply  on  floss-silk. 

For  Neuralgia  and  Tumors  of  the 
Gums. 
R.    Iodoformi      ....  gr.xv 
Bals.  Peru     .    .        .  gr.xxx 
Glycerini  vel  vaselin  q.  s.  M. 

To  make  a  solution  or  ointment. 


SiGNA. — To  be  applied  as  a  solutio  n 
or,  if  the  vaseline  is  used,  as  an  oint- 
ment. 

For  Pulpitis,  as  a  Capping. 
Paschkis. 
R .    Iodoform  pulv., 

Kaolin  pulv.     .    .    .  aa  gr.lx 
Acidi  carbolici  (cryst.)  gr.viij. 
Mix,  and  add  sufficient  glycerine  to 
form  a  paste,  then  add : — 

01.  nienth.  pip.     .    .  gtt.x. 
Signa. — Apply  on  point  of  broach  over 
inflamed  portion. 

For  Tumors,  Enlarged  Glands,  etc. 
B .    Iodoformi      ....  part  j 

Collodii part  x.       M. 

SiGNA. — To  be  applied  as  a  lotion. 

For   Pulpless    Teeth — Canal-Dressing. 

Dr.  Peirce. 
li .    Iodoformi, 

Olei  caryophilli, 

Olei  eucalypti  .    .    .  aa  ^  vj.     M. 
SiGNA. — Apply  by  injection  or  on  floss- 
silk. 

For  an  Ointment  of  Iodoform  and 
Eucalyptus. 
R.    Pulv.  Iodoformi    .       ^ss 
Olei  eucalypti  .  .    .  f  J  ss 
Vaselin  ....  Jiv.         M. 

SiGNA. — To  be  used  as  an  ointment. 


Tetra-iodo-ethylene-Di-odoform  is  a  substitute  for  iodo- 
form, which  it  resembles  in  chemical  composition,  and  contains 
the  largest  percentage  of  iodine  next  to  iodoform.  Its  formula 
is  C2I4,  and  it  is  regarded  as  a  condensation  product  of  two  mole- 
cules of  iodoform,  2CHI3 — 2HI=C2l4.  It  is  prepared  from 
acetylene  di-iodide,  C2I2,  by  dissolving  in  carbon-bisulphide, 
adding  the  equivalent  of  iodine  and  evaporating.  This  residue 
is  insoluble  in  water,  but  can  be  recrystallized  out  of  bisulphide, 


lODOL.  435 

chloroform,  benzene,  or  toluene  in  the  form  of  yellow  prisms 
melted  at  192°  C.  It  is  unattacked  by  boiling  nitric  acid,  but 
decomposed  by  alcoholic  potash.  It  is  free  from  the  odor  of 
iodoform. 

lODOL— lODOLUM. 

Formula.— CJJSiH,. 

Derivation. — lodol  is  obtained  by  the  action  of  iodine  on  cer- 
tain constituents  of  animal  oil.  It  is  in  the  form  of  a  grayish- 
white  powder,  which  becomes  dark  on  exposure  to  light. 

It  is  odorless  and  has  little  taste,  and  contains  90  per  cent,  of 
iodine.  It  is  quite  soluble  in  alcohol,  ether,  chloroform,  carbolic 
acid,  olive  oil  and  alkaline  solutions,  but  insoluble  in  water; 
combination  with  an  equal  part  of  glycerine  does  not  affect  its 
properties. 

Medical  Properties  and  Therapeutic  Uses. — lodol  is  antiseptic, 
deodorant  and  anaesthetic.  It  is  an  efficient  germicide  without 
poisonous  effects,  and  is  free  from  the  disagreeable  odor  and  taste 
of  iodoform.  Its  physiological  action  and  therapeutic  uses  are 
the  same  as  those  of  iodoform.  When  applied  to  an  abraded  or 
wounded  surface,  it  can  soon  be  detected  in  the  urine  and  saliva; 
also  the  same  effects  are  apparent  when  it  is  administered  by  the 
stomach. 

Its  action  is  slower  than  that  of  iodide  of  potassium,  but 
more  prolonged,  and  its  elimination  is  slower.  It  has  a  slight 
caustic  action,  but  a  larger  quantity  can  be  used  when  it  is  sub- 
stituted for  iodoform ;  no  quantity  applied  to  a  wound  will  cause 
toxic  symptoms. 

It  is  used  on  wounds,  ulcers,  etc.,  in  the  form  of  an  impalpable 
powder,  which  is  dusted  on  the  part.  It  is  also  employed  in  the 
form  of  an  ethereal  solution,  and  also  in  solution  with  alcohol 
and  glycerine ;  also  in  the  forms  of  iodol  cotton  and  gauze,  pastils, 
bougies  and  ointments.  It  improves  morbid  conditions,  and  can 
be  advantageously  substituted  for  iodoform.  It  has  been  admin- 
istered with  good  results  in  the  treatment  of  laryngeal  tuber- 
culosis by  insufflation  of  the  powder;  and  the  loss  of  appetite,  so 
common  as  a  result  of  the  use  of  iodoform,  does  not  occur,  ulcers 


436  DENTAL  MEDICINE. 

become  rapidly  clean  and  the  tendency  to  form  scars  is  scarcely 
observed. 

lodol  is  also  employed  internally,  in  the  form  of  pills  of  3 
grains  in  the  treatment  of  substernal  struma.  In  the  treatment 
of  syphilitic  ulcers,  round  ulcers,  suppurating  buboes,  and  after 
opening  the  pustules  of  acne,  it  has  also  given  favorable  results, 
as  it  lessens  the  secretion,  possesses  great  disinfectant  power  and 
is  non-irritating. 

Dose. — For  internal  administrations,  gr.  y^  to  gr.  v,  in  wafer, 
pill,  or  pellet,  or  in  powder. 

Dental  Uses. — Same  as  those  of  Iodoform  (which  see). 

DENTAL  FORMULAE. 

For  a  Topical  Application.  Vaseline  carbol.   q.  s.  to   form  a 

Mazzoni.  thick  paste.                          M. 

R .     lodol                                  I  part  Signa. — Place  in  canal  and  seal  with 

Alcoholis     ......     16  parts  an  oxyphosphate  filling. 

Glycerini 34  parts 

Signa.  —  Apply  with  a  camel's-hair 

,       ,        •     ,,     r  f  for  a  Topical  Application. 

brush  or  m  the  form  of  a  spray.  ^  ^-^ 

Evaporating  quickly. 
Dental  Varnish. 

R.     lodol I  part 

R.     Saturated  solution  of  lodol  ^^j^^^^   ^^,pj^_         g  p^,.^^^       ^^ 

in  alcohol    ...     I  part 

Hubbard's    negative   var- 
nish       6  parts.  M.       /r^^   Abrasions  0/ Lips   and  Nostrils. 

A  good,  quick  drying  varnish. 

^  *  '      ^  INGALLS. 

For  Root-Canals  of  Abscessed  Teeth.  n.     lodol  gr.xxv 

Van  Wort.  Acidi  carbol  ici   .  Hlvj 

R .     lodol gr.x  Lanolin  ....  5  ss 

Zinci  oxidi gr.xx  01.   roste    .    .    .  TTLv.             M. 

lODUM— IODINE. 

Symbol. — I. 

Derivation. — Iodine  is  a  non-metallic,  metalloid  element,  ob- 
tained principally  from  kelp  (made  by  burning  seaweed,  and  in 
the  form  of  impure  soda),  which  is  subjected  to  distillation  in 
iron  retorts,  after  which  it  is  mixed  with  sulphuric  acid  and  black 
oxide  of  manganese.  It  is  evolved  in  the  form  of  vapor,  which 
is  condensed.     The  vapor  is   readily  recognized  by  its  beautiful 


IODINE.  437 

violet  color.  Iodine  is  usually  in  the  form  of  bluish-black  crys- 
talline scales,  with  a  metallic  lustre,  a  strong,  peculiar  odor  and 
a  hot,  acrid  taste.  It  is  slightly  soluble  in  water,  and  soluble  in 
alcohol,  ether,  solution  of  chloride  of  sodium  and  a  solution  of 
iodide  of  potassium. 

Medical  Properties  and  Action. — Iodine  in  small  doses  is  alter- 
ative, stimulant  and  tonic,  and  acts  locally  as  an  irritant,  causing 
redness,  itching  and  desquamation  ;  exhaled  in  the  form  of  vapor, 
it  excites  cough  and  warmth  in  the  air  passages.  Taken  inter- 
nally it  excites  a  sensation  of  heat  or  burning  in  the  stomach,  and 
in  large  doses  is  an  irritant  poison,  inflaming  the  mucous  mem- 
brane of  the  stomach  and  causing  superficial  eschars.  The  in- 
ternal use  of  the  iodides  gives  rise  to  an  eruption  of  acne,  espe- 
cially on  the  face,  thighs  and  shoulders ;  they  have  also  anaphro- 
disiac  powers  when  long  continued.  The  influence  of  the  iodides 
in  producing  iodism  may  be  prevented  by  large  drafts  of  water 
being  used  during  their  administration. 

The  odor  of  iodine  can  be  detected  in  the  blood,  brain  and 
muscles. 

When  combined  with  potassium  its  local  irritant  effect  is  di- 
minished ;  hence  the  preparation  known  as  Iodide  of  Potassium, 
Potassii  lodidum  (obtained  by  treating  an  aqueous  solution  of 
potassa  with  iodine),  is  employed  whenever  the  constitutional 
effects  of  iodine  are  desired,  as  the  iodide  of  potassium  possesses 
many  advantages  over  iodine  for  internal  use,  such  as  being  less 
irritant,  and  for  this  reason  may  be  administered  in  larger  doses 
and  for  a  greater  length  of  time  ;  it  is  also  more  soluble  than 
iodine  alone,  and  when  taken  into  the  stomach  is  absorbed  much 
more  rapidly.  The  formula  is  Ki,  and  it  is  in  the  form  of  white 
crystals,  of  an  acrid,  saline  taste.  Some  persons  are  peculiarly 
susceptible  to  the  influence  of  iodine,  even  small  doses  causing 
unpleasant  effects,  such  as  headache,  vertigo,  derangement  of  the 
digestive  organs,  etc. 

Iodide  of  potassium,  like  iodine,  produces  a  very  decided  effect 
on  the  secretions,  increasing  them,  and  occasionally  to  the  degree 
of  ptyalism.     The  antidote  for  poisoning  by  iodine  is  starch. 

Therapeutic  Uses. — Iodine  and  its  preparations  are  valuable  re- 


438  DENTAL  MEDICINE. 


solvents  in  the  treatment  of  glandular  enlargements,  indurations, 
tumors,  thickening  of  membranes,  etc.,  etc. ;  also  in  scrofula, 
scrofulous  ophthalmia,  tubercular  meningitis,  advanced  stage  of 
pleurisy,  chronic  affections  of  the  liver,  etc.,  etc. 

Iodide  of  potassium  is  much  employed  in  mercurial  poisoning 
and  in  syphilis,  especially  in  the  secondary  and  tertiary  forms, 
and  after  the  employment  of  mercury  has  proved  useful ;  also  in 
affections  of  the  nervous  system  of  a  syphilitic  origin,  together 
with  the  other  affections  already  referred  to  as  indicating  iodine. 
Externally  iodine  is  used  in  the  form  of  tincture  in  the  treatment 
of  enlarged  scrofulous  glands,  cutaneous  affections,  erysipelas, 
rheumatism,  gout,  phlegmons,  syphilitic  gummatas  and  nodes, 
phagedaenic  ulcerations,  carbuncles,  diseases  of  the  joints,  wounds 
and  parts  poisoned;  and  as  a  counter-irritant  in  pneumonia, 
phthisis  and  pleurisy ;  and  as  injections  in  hydrocele  and  bron- 
chocele.  The  vapor  is  inhaled  with  benefit  in  chronic  bronchitis 
and  phthisis.     Iodine  also  ranks  highly  as  a  disinfectant. 

Dose. — Of  iodine  alone,  gr.^  to  gr.  j  two  or  three  times  a  day, 
in  the  form  of  a  pill,  directly  after  eating  on  account  of  its  irri- 
tant effect;  the  best  form  of  administration,  however,  is  iodide  of 
potassium.  Dose  of  the  iodide  of  potassium,  gr.  iij  to  gr.  x.  A 
new  way  of  giving  iodine  internally  is  by  dissolving  iodine  in 
water  with  four  times  its  weight  of  iodide  of  potassium,  and  mix- 
ing with  glucose. 

Tincture  of  Iodine — Tinctura  lodi  (iodine,  5j  ;  alcohol,  Oj). 
Dose,  mj  to  lUv. 

Compound  Tincture  of  Iodine — Tinctura  lodi  Composita  (iodine, 
5ss  ;  iodide  of  potassium,  §j  ;  alcohol,  Oj).     Dose,  TTLij  to  TTLx. 

A  new  tincture  of  iodine  has  been  introduced  by  Prof.  Elsberg, 
which  may  be  substituted  for  the  officinal  tincture,  and  which 
can  be  combined  with  tincture  of  aconite  root. 

It  is  claimed  that  it  is  much  stronger  than  the  officinal  7  per 
cent.,  as  it  contains  20  per  cent,  of  iodine ;  and  that  no  poison- 
ous effects  have  resulted  from  its  use  ;  one  application  being  as 
beneficial  as  four  of  the  officinal  tincture.  The  formula  is  iodine 
20.0  ;  alcohol,  ether,  fia  40.00. 

Colorless  Iodine. — Iodine   is   bleached   by  carbolic  acid,  and  the 


IODINE.  439 

colorless  carbolate  combines  all  the  advantages  of  both  base  and 
acid.  One  of  the  easiest  methods  to  decolorize  iodine  is  to  add 
forty  minims  of  a  saturated  solution  of  hyposulphite  of  soda  to 
each  fluid  ounce  of  the  tincture  of  iodine.  Forty  minims  of  the 
saturated  solution  contain  about  thirty-two  grains  of  sodic  hypo- 
sulphite. Another  method  of  decolorizing  iodine  is  to  put  into 
an  open  vessel  a  drachm  of  the  tincture  of  iodine  and  six  ounces 
of  hot  water  ;  add  twelve  grains  of  phenol,  and  stir  with  a  glass 
rod,  when  the  solution  will  be  at  once  bleached. 

Dental  Uses. — In  dental  practice  iodine  and  its  preparations  are 
valuable  agents,  the  official  and  compound  tinctures  being  em- 
ployed in  the  treatment  of  periodontitis,  alveolar  abscess,  mer- 
curial stomatitis  and  other  forms  of  stomatitis,  inflammation  and 
ulceration  of  the  gums,  fungous  growths  of  gum  and  tooth  pulps, 
necrosed  teeth  and  suppurating  pulps  of  teeth,  diseases  of  the 
antrum,  caries  of  maxillary  bones,  dentigerous  cysts,  recession  of 
gums  and  absorption  of  alveolar  processes.  The  combination  of 
equal  parts  of  tincture  of  iodine,  tincture  of  aconite,  tincture  of 
canabis  indica  and  compound  tincture  of  benzoin  to  be  locally 
applied,  is  a  more  effectual  remedy  than  the  former  aconite  and 
iodine  mixture,  for  periodontitis,  pulpitis,  inflammation  about 
erupting  third  molars,  and  incipient  alveolar  pyorrhoea.  It  is 
a  counter-irritant  and  will  often  abort  a  forming  abscess. 

For  the  different  forms  of  stomatitis,  and  especial  mercurial 
stomatitis,  the  tincture  of  iodine  is  used  in  the  form  of  a  gargle; 
for  an  injection  in  alveolar  abscess  it  is  diluted  or  combined  with 
carbolic  acid,  glycerin  and  other  agents ;  for  fungous  growths  it 
may  be  used  alone,  or  combined  with  rectified  alcohol ;  for  ulcer- 
ations of  gum  and  mucous  membrane  it  is  generally  combined 
with  carbolic  acid ;  for  periodontitis  it  is  combined  with  the 
tincture  of  aconite  root,  and  is  regarded  as  being  almost 
a  specific  for  the  incipient  stages  of  this  affection,  as  it  relieves 
the  inflammation  by  retarding  the  circulation  and  stimulating 
lymphatic  action.  Either  the  officinal  or  compound  tincture  is 
employed  with  an  equal  quantity  of  the  tincture  of  aconite,  the 
preparation  being  applied  to  the  gum  over  root  of  affected  tooth, 
which   should   be  previously  dried    of  moisture,  by  means  of  a 


440  DENTAL  MEDICINE. 


camel's^hair  brush  or  cotton  on  the  point  of  an  excavator.  The 
mouth  should  be  kept  open  and  the  part  protected  until  a  me- 
tallic pellicle  is  formed.  Iodine  is  also  a  valuable  disinfectant 
and  germicide  in  the  treatment  of  alveolar  abscess  (in  the  form 
of  the  compound  tincture),  used  as  injection  throughout  the  pus 
tract,  and  for  root  canals  and  the  pus-pockets  of  alveolar  pyor- 
rhoea. 

A  valuable  combination  of  iodine,  carbolic  acid,  glycerin  and 
water  is  known  as  "  Boulton's  Preparation,"  and  is  a  useful  ap- 
plication in  the  form  of  injections,  gargles  and  lotions.  For  the 
chronic  form  of  alveolar  abscess,  and  also  for  the  acute  form, 
after  more  powerful  agents  have  been  employed,  it  is  a  useful 
remedy,  possessing  antiseptic  and  stimulant  properties  in  a  marked 
degree;  it  also  possesses  the  property  of  modifying  mucous  mem- 
brane and  diminishing  sensibility;  hence  it  is  useful  in  ulcer- 
ations, etc.  Tincture  of  iodine  combined  with  creasote  or  car- 
bolic acid  is  a  powerful  application  in  periodontitis,  suppuration 
of  necrosed  teeth,  ulceration  of  margins  of  the  gums  and  for 
fungous  growth,  as  it  stimulates  debilitated  parts  and  destroys 
such  as  are  too  weak  to  be  restored.  A  colorless  tincture  of 
iodine  is  composed  of  glycerin  and  aqua  ammonia  in  combina- 
tion with  the  iodine,  but  the  presence  of  the  ammonia  restricts  its 
use.  Another  colorless  tincture,  in  which  sulphate  of  soda  is 
substituted  for  the  ammonia,  is  less  irritating  in  its  effects. 

The  addition  of  water  and  honey  to  the  officinal  tincture  of 
iodine  will  render  it  suitable  for  a  gargle  for  inflamed  and  ulcer- 
ated parts.  The  iodide  of  potassium  is  employed  internally  in 
mercurial  stomatitis,  dental  exostosis,  facial  neuralgia,  convul- 
sions of  dentition,  periodontitis,  looseness  of  the  teeth,  tume- 
faction and  sponginess  of  the  gums,  syphilitic  and  scrofulous 
ulcerations  of  the  mouth,  caries  and  necrosis  of  the  maxillary 
bones. 

Tincture  of  iodine  mixed  with  glycerin  is  claimed  by  Dr. 
Hammond  to  be  more  effective  as  a  local  application  than  the 
plain  tincture.  This  is  due  to  the  retardation  of  the  dissipation 
of  the  iodine,  or  more  probably  to  the  skin  remaining  soft,  and 
therefore  in  a  better  condition  for  absorbing  the  drug. 


IODINE. 


441 


Iodine  Trichloride  is  formed  by  passing  chlorine  gas  over  iodine. 
It  is  obtained  in  the  form  of  reddish  crystals,  is  soluble  in  its  own 
weight  of  water,  and  almost  as  readily  in  alcohol,  and  either 
solution  can  be  mixed  with  glycerol  without  decomposition. 
Dr.  Belfield  regards  it  as  a  powerful  local  antiseptic  for  irrigating 
suppurating  wounds,  and  tuberculous  processes.  He  uses  solu- 
tions of  5  to  20  per  cent,  in  equal  parts  of  water,  alcohol  and 
glycerol. 


DENTAL  FORMULA. 


For   Periodontitis,  Pulpitis,  Injlamtna- 
tion  from    Erupting  Teeth,  Abor- 
ting Abscesses,  Insipient  Alveo- 
lar Pyorrhcea. 

R .    Tinct.  lodi 

Tinct.  aconiti 
Tinct.  can.  indica. 
Tinct.  benzoin  comp.  aa  parts. 
SiGNA. — Apply  locally  drying  surfaces 
and  keeping  them  dry  for  a  minute 
after,  to  facilitate  absorption. 


For  Chronic  Alveolar  Abscess,  Ulcera- 
tions, Inflammations,  etc.,  etc. 

BOULTON. 
R.    Tinct.  iodi.  comp.    .    .  TTLxlv 
Acidi  carbolici  (cryst.),  y(\\] 

Glycerini ^j 

AquEe  destillatse  .    .    .  ^v.        M. 
It  becomes  colorless  in  from  8  to  10 
hours. 

SiGNA. — To  be  used  as  injection,  gar- 
gle or  lotion. 


For  Periodontitis. 

R.    Tinct.  iodi |j 

Creasoti  vel., 

Acidi  carbolici  .  .  .  ^ss.  M. 
SiGNA. — To  be  applied  to  gum  about 
neck  of  tooth,  as  a  counter-irritant. 


For  Ulcerated  Gums  and  Mucous 
Membrane. 

R .    Tinct.  iodi partem  j 

Mellis partes  ij 

Aqu?e         partes  vij.  M. 

SiGNA. — To  be  used  as  a  gargle. 

For  Periodontitis. 

R.    Tinct.  iodi :^x 

Potassii  iodidi  .    .  .    .  ,^ss 

Camphorse         .    .  .    .  ^ij  • 

Spiriti  rectificati  .  .    .    f^x.     M. 

SiGNA. — Apply    with  a    camel's-hair 

brush  to  gum  over  root  of  affected 
tooth. 


For  Ulceration  of  Gums. 


R.    Tinct.   iodi 

Acidi    carbolici    .    . 

Glycerini  .    .    . 

Aquce  destillatae  .    . 
SiGNA. — Apply  as  a  lotion 


mvj 

I) 


M, 


For  Fungous  Growths  and  Suppu- 
rating Surfaces. 

R.    Tinct.  iodi ^ij 

Spiriti  rectificati  .    .    .   ^j.         M. 
SiGNA. — To  be  applied  with  a  camel's- 
hair  brush. 


442  DENTAL  MEDICINE. 


For  Mercurial  Stomatitis.  Signa. — Apply     as     an     embrocation 

R.    Tinct.  iodi giijvelvj  twice  a  day,  having  previously  well 

Potassii  iodidi  .    .    .  gr.xv  vel  xxx  bathed  the  hands  in  warm  water,  in 

^qujg                           Oss.            M.  which    is   dissolved    2   drachms   or 

Signa.— To  be  used  as  a  gargle.  ^^^f   an   ounce   of  chloride   of  am- 
monia and  4  drachms  of  carbonate 

For  Periodontitis.  of  soda  crystals,  enough  water  being 

R      Tinct.  iodi.  tised  to  well  cover  the  hands. 

Tinct.  aconiti  .    .    .  aa  ^  ss.       M, 

Signa. — To  be  applied  by  means  of  a  For  Putrescent  Pulps  and  Chronic 

camel's-hair  brush  until   a  metallic  Alveolar  Abscess. 

pellicle  is  formed,  three  times  daily,  g,  ^    jgdi                                  t  ij 

Alcoholis f^'j.      M. 

For  Excessive  Sweating  of  the  Hands. 

R     Tinct    iodi.                         zi  ^^''^  Same  and  Pyorrhea  Alveolaris, 

Lin.  camphorae  comp.,  R .    Iodi. 

Glycerin!     .    .    .    .  aa  ^^iss  Acidi    carbolici    (crys- 

Lin.  belladonna  comp.  ^^j  tals) aa  ^j 

Eau  de  cologne  .    .    .  gj.        M.  Alcoholis f^ij-      M. 


IODINE  TRI-CHLORIDE— TRICHLORIDE  OF  IODINE. 

Formula. — ICI3. 

Derivation. — Iodine  tri-chloride  is  obtained  by  the  action  of 
chlorine  gas  over  iodine.  It  is  an  orange-red  powder,  whose 
odor  strongly  irritates  the  mucous  membrane.  Usual  dilution 
I  in  1200. 

Medical  Properties  and  Therapeutic  Uses. — Tri-chloride  of 
iodine  is  antiseptic  and  disinfectant,  being  highly  efficient  as 
such,  through  the  liberation  of  chlorine,  whose  nascent  energetic 
effect  is  still  further  enhanced  by  the  presence  of  iodine.  The 
antiseptic  power  of  tri-chloride  of  iodine  was  officially  tested  by 
the  Imperial  Sanitary  Bureau  of  Germany,  and  the  following  re- 
sult was  ascertained:  "An  aqueous  solution  of  i  in  1000  de- 
stroys resistent  bacillus-spores  within  a  comparatively  short  time  ; 
but  only  the  aqueous  solution  does  this.  Alcoholic  or  oily  solu- 
tions proved  ineffective.  Iodine  tri-chloride  far  surpasses  car- 
bolic acid,  and  is  next  to  corrosive  sublimate  (bi-chloride  of  mer- 
cury), in  antiseptic  power."  It  may  be  obtained  in  quantities  of 
ten  grammes  in  hermeticallv  sealed  tubes,  and  is  best  kept  in  five 
per  cent,  aqueous   solutions  which   appear   to  remain  unchanged 


ORRIS  ROOT.  443 


for  some  months.  Langebuch  claims  that  a  o.i  to  0.15  per 
cent,  solution  is  equal  in  antiseptic  action  to  a  0.5  to  i.o  per 
cent,  solution  of  bi-chloride  of  mercury  ;  in  other  words,  that  it 
is  about  five  times  as  efficient  as  the  bi-chloride.  It  is  also 
claimed  to  be  relatively  the  least  poisonous  of  all  antiseptics. 
Behring  found  that  in  aqueous  solutions^  having  equal  action  upon  the 
spores  of  anthrax  bacilli,  sublimate  is  five  to  six  times,  and  car- 
bolic acid  and  creasote  seven  to  eight  times,  as  poisonous  as  the 
tri-chloride. 

Dental  Uses. — Dr.  W.  D.  Miller  says:  "We  have  conse- 
quently reasons  to  hope  that  the  tri-chloride  of  iodine  may  prove 
a  valuable  remedy  in  the  treatment  of  diseased  conditions  of  the 
teeth  and  mouth."  Its  efficiency  as  a  disinfectant  for  carious 
dentine  has  been  clearly  shown  in  the  experiments  of  Dr.  Miller, 
and  his  impression  was  that  the  five  per  cent,  solution  of  the  tri- 
chloride of  iodine  is  one  of  the  most  active  agents  for  sterilizing 
carious  cavities,  and  disinfecting  carious  dentine  preparatory  to 
filling  teeth. 

IRIDIS   RHIZOME— ORRIS  RHIZOME— ORRIS  ROOT. 

Source. — The  plant  from  which  Orris  Root  is  obtained  is  a 
native  of  Italy  and  the  south  of  Europe.  It  belongs  to  the  natural 
order  Iridacea?,  of  which  there  are  three  varieties  of  the  species  of 
Iris — Iris  Rhizoma.,  Iris  Floretitina  and  Iris  Germanica.  The  root, 
which  is  the  officinal  portion  of  the  plant,  is  of  various  forms  and 
sizes,  often  branched,  usually  knotty  and  flattened,  white,  heavy, 
and  of  the  thickness  of  the  finger.  It  has  a  pleasant  odor,  like 
that  of  violet,  and  a  bitter,  acrid  taste^- 

Medical  Properties  and  Action. — Orris  root  is  cathartic  and 
diuretic,  and  in  large  doses  emetic.  It  has  beem  employed  with 
some  benefit  in  dropsies,  but  is  not  often  administered  as  an  in- 
ternal remedy  at  the  present  time.  It  is  valued  for  its  pleasant, 
violet  odor. 

Dental  Uses. — In  dental  practice  it  is  employed  as  a  very 
common  ingredient  of  dentifrices,  and  also  to  correct  an  offensive 
breath. 


444  DENTAL  MEDICINE. 


DENTAL     FORMULA. 

Dentifrice. 

Dr.  Sewell. 

R         Pulv.  radicis  iridis ^ss 

Pulv.  saponis  cas ^  ij 

Pulv.  sodii  boratis ^  ij 

Cretse  preparatse ^  ij.        M. 

Flavor  with  a  few  drops  of  oil  of  cloves  and  lavender.  Or,  add  a 
few  drops  of  carbolic  acid  to  each  ounce  of  the  powder,  and  flavor 
the  whole  with  eucalyptus  oil.  (For  other  dentifrices  see  Prepared 
Chalk.) 

ISONANDRA  GUTTA— GUTTA  PERCHA. 

Source. — Gutta  Percha  is  the  inspissated  juice  of  the  tree 
honandra  Gutta.^  extensive  forests  of  which  are  found  in  the  East 
Indies.  It  belongs  to  the  natural  order  Sapotacece.  It  is  in  the 
form  of  tough,  flexible  pieces,  which  have  been  freed  from  im- 
purities by  cutting  it  into  thin  slices,  and  then  washing  and  tear- 
ing it  into  shreds  by  heavy  machinery  while  it  is  softened  in  boil- 
ing water.  It  may  be  more  thoroughly  purified  by  dissolving  it 
in  either  chloroform,  benzol  or  hot  turpentine,  thus  causing  the 
impurities  to  separate,  when  it  is  evaporated  to  dryness.  Crude 
gutta  percha  is  of  a  chocolate  or  reddish-brown  color  ;  commer- 
cial gutta  percha  is  of  a  grayish-white  color,  and  the  variety  which 
has  been  purified  by  dissolving  it  in  chloroform,  etc.,  is  almost 
white,  greasy  to  the  touch,  and  of  a  leathery  smell,  like  that  of 
India  rubber.  It  is  insoluble  in  water  at  any  temperature,  and  is 
a  bad  conductor  of  heat  and  electricity.  At  ordinary  tempera- 
tures it  is  tough,  hard  and  inelastic,  but  toward  120°  F.  it  softens, 
and  at  150°  it  becomes  soft  and  plastic,  and  may  be  moulded  into 
any  form,  which  it  will  retain  on  cooling,  having,  however,  a 
perceptible  shrinkage.  Gutta  percha  is  dissolved  cold  by  chloro- 
form and  sulphide  of  carbon;  benzol  requires  the  aid  of  heat,  and 
oil  of  turpentine  requires  to  be  quite  hot.  The  alkalies  have  no 
action  upon  it;  but  concentrated  nitric  acid  attacks  it  rapidly, 
with  effervescence  and  the  escape  of  nitrous  fumes. 


GUTTA   PERCHA.  445 


Dental  Uses. — Combined  with  mineral  substances  it  forms  a 
plastic  material  for  temporary  fillings  of  teeth,  and,  colored  with 
vermilion,  is  used  for  taking  impressions  of  the  mouth  and  for  the 
base  plates  of  plastic  work.  It  is  often  employed  as  a  filling 
material,  on  account  of  its  non-conducting  property,  protecting  a 
partially  exposed  pulp  or  sensitive  dentine  surface  from  irritation 
when  metallic  fillings  would  not  be  tolerated.  Gutta  percha  has 
also  been  used  for  interdental  splints. 

The  preparation  known  as  "  Hill's  Stopping  "  is  composed  of 
gutta  percha,  quicklime  and  feldspar,  the  mineral  ingredients  be- 
ing incorporated  with  the  gutta  percha  while  the  latter  is  in  a 
plastic  condition  from  the  effects  of  heat. 

Solution  of  Gutta  Percha — Liquor  Gutta  Percha,  Chloro- 
percha,  is  composed  of  gutta  percha,  .3iss  ;  chloroform,  .5xvij  ;  or 
a  thick  solution  may  be  made  by  dissolving  as  much  gutta  percha 
in  chloroform  as  will  give  the  desired  consistence  (generally  like 
that  of  thick  cream). 

Solution  of  gutta  percha  is  a  useful  application  for  the  relief  of 
odontalgia  arising  from  an  exposed  and  inflamed  pulp  \  also  for 
capping  an  exposed  pulp,  a  more  durable  material  being  inserted 
over  it.  The  chloroform  of  the  solution  quickly  evaporates,  leav- 
ing an  impermeable  covering  of  the  gutta  percha,  which  is  non- 
irritable,  non-conductive  and  protective.  It  is  also  a  useful 
application  for  inflamed  or  abraded  surfaces,  chaps,  skin  affections, 
etc.  Gutta  percha  dissolved  in  chloroform  {chloro-perchd)  is  also  a 
popular  and  efficient  material  for  root  fillings,  as  are  also  cones  of 
gutta  percha  softened  by  heat  or  dipped  in  chloroform.  The  chloro- 
percha  solution  and  cotton  is  a  useful  agent,  the  chloro-percha 
solution  being  of  such  a  consistence,  neither  too  thin  nor  too 
thick,  that  the  cotton  will  absorb  it.  Being  of  an  adhesive  nature, 
it  will  readily  adhere  to  walls  of  cavities  and  to  tooth-surfaces, 
and  is  useful  to  retain  medicines  and  exclude  moisture,  to  wedge 
the  teeth,  to  force  back  gum  tissue,  to  assist  in  retaining  clamps 
in  position,  etc.  The  red  gutta  percha  of  base  plates  is  preferred 
by  some  in  making  the  chloro-percha  solution  on  account  of  its 
color  rendering  it  easy  to  detect  in  the  mouth,  and  also  to  deter- 
mine how  much  of  the  solution  the  cotton  has  absorbed. 


446  DENTAL  MEDICINE. 


KANDOL, 

Kandol  is  a  product  formed  by  the  distillation  of  naphtha,  and 
is  a  perfectly  clear,  colorless  fluid,  extremely  volatile,  burns  easily, 
and  has  a  slight  odor  of  benzine.  It  can  be  mixed  with  a  small 
quantity  of  water  or  alcohol,  and  its  preparation  is  cheap  and 
simple.  Dr.  Njuschkon  advocates  the  use  of  kandol  in  the  place 
of  ether  or  cocaine  as  a  local  anaesthetic  in  the  form  of  spray.  In 
one  minute  kandol  will  reduce  the  temperature  to  io°  C,  and 
keep  it  nearly  uniform  at  that  temperature  for  some  time,  while 
ether  reduces  the  temperature  to  17°  C.  As  an  effect  of  the 
spray  of  kandol,  the  skin  becomes  very  hard  and  is  completely 
anaesthetized,  and  there  is  no  bleeding,  or  else  the  blood  coagu- 
lates as  soon  as  it  makes  its  appearance,  so  that  all  operations  may 
be  performed  with  ease  and  rapidity. 

KRAMERIA. 
RHATANY. 

Source. — Krameria  is  obtained  from  the  root  of  the  shrub 
krameria  triandra,  of  the  natural  order  Polygalea^  native  of  Peru. 
It  is  in  the  form  of  cylindrical  pieces,  of  the  thickness  of  a  quill, 
with  many  branches  of  a  light  red  color  within  and  crossed  by  a 
reddish-brown  bark.  The  root  is  without  odor,  and  of  an 
astringent  and  somewhat  bitter-sweetish  taste. 

Medical  Properties  and  Action. — Krameria  is  a  powerful  astrin- 
gent, its  medicinal  property  being  due  to  tannic  acid,  of  which  it 
contains  about  forty  per  cent.  There  is  also  present  an  odorous 
principle,  wax  gum,  and  a  peculiar  acid  known  as  krameric  acid. 
When  chewed  it  imparts  a  red  tinge  to  the  saliva.  It  imparts  its 
properties  very  readily  to  alcohol,  but  less  so  to  both  cold  and 
boiling  water. 

Therapeutic  Uses. — Krameria  is  employed  internally  for  its 
astringent  and  a  slightly  tonic  effect  in  the  treatment  of  diarrhoea, 
dysentery,  passive  hemorrhages,  menorrhagia,  leucorrhoea,  etc. 
Externally,  in  the  form  of  powder,  tincture  and  infusion,  in  the 
treatment  of  ozaena,  ophthalmia,  etc.,  and  as  an  enema  in  hemor- 
rhoids, fissures  of  the  anus,  sore  nipples,  leucorrhoea,  etc.,  etc. 

Dose. — Of  powdered    krameria,    gr.    xx    to  gr.  xxx ;  of  the 


LANOLIN.  447 


extract — extractum  krameria^  the  dose  is  gr.  v  to  gr.  x  ;  of  the 
infusion — infusum  krameria — (krameriae  5j  ;  water,  Oj),  the 
dose  is  .5ss  to  .5]  ;  of  the  tincture^//«f/«r^  ^r<»wm<^ — (krameriae, 
.5v'j  ;  diluted  alcohol,  Oij),  the  dose  is  5j  to  5ij-  Of  the  fluid 
extract — extractum  krameria:  Jiuidum^  the  dose  is  TTlv  to  5ss ;  of 
the  syrup — syrupus  krameria^  the  dose  is  5j  to  5'v« 

Dental  Uses. — Krameria  is  a  valuable  astringent  in  dental  prac- 
tice, being  employed  in  the  form  of  the  tincture,  in  ulcerated  and 
spongy  gums ;  in  the  form  of  the  infusion,  as  a  gargle  in 
inflammation  of  the  gums  and  mucous  membrane ;  in  the  form 
of  the  powder  and  also  tincture,  in  spongy  and  bleeding  gums,  as 
an  astringent ;  and  also  in  the  form  of  the  powder  as  an  ingredient 
of  dentifrices,  for  its  astringent  property. 

DENTAL    FORMULA. 
Astringent     and     Stimulant      Mouth  For  Gingivitis. 

,,       ^  V  '  Dr.  Sabatir. 

K  •     Tinct.  krameriae, 

Boro-glyceride,  R      Tinct.  krameria:     .    .    .  ^j 

Eau  de  cologne  .    .  aa^j  Tinct.  opii ^ij 

Spts.  vini.  recti    .   ad.  |  viij.    M.  Tinct.  myrrhse    .    .    .    .  ^  j 

SiGNA.— A  teaspoonful  to  be  added  to  Aquae  camph gvj.    M. 


a  little  water.  Signa. — Use  as  a  mouth  wash. 

For     Inflamed     Gums    and    Mucous 
Membrane. 
Thomas. 
R.     Pulv.  krameriae, 

Pulv.  cinnamomi    .  aa  3J  R. 

Aquae  bullientis  .    .    .  f^vii. 
Macerate  for  2  hours,  strain,  and  add 
sacchari  ^ij. 
Signa. — To  be  used  as  a  gargle. 

LANOLIN. 
Lanolin  is  the  natural  fat  of  wool  and  is  used  as  a  substitute 
for  ordinary  fat  for  local  use.  On  account  of  its  being  analogous 
to  the  natural  fat  of  the  skin,  it  is  supposed  to  be  more  freely 
absorbed  by  the  tissues  than  the  ordinary  fats  ;  hence  it  is  em- 
ployed as  a  vehicle  for  remedies  which  are  to  be  absorbed,  and 
for  such  a  purpose  has  been  combined  with  arsenious  acid  and 
hydrochlorate  of  cocaine  in  a  devitalizing  mixture. 


Sty  pic  for  Bleeding 

Gums.      « 

ViAU. 

Tincturas  kramericC 

•    fsJ 

Chloroformi    .    .    . 

■  gr.6o 

Acidi  tannici  .    .    . 

.  grs.xxx 

Menthol 

.  grs.xxx 

Aquae  deslillatas  . 

.  fjxvij.  M. 

448  DENTAL  MEDICINE. 


DENTAL    FORMULA. 
For  Soft,    White  Hands. 

R .  Lanolin 20  parts 

Glycerine 20  parts 

Borate  of    soda 10  parts 

Oil  of  eucalyptus 2  parts 

Essence  of  bitter  almonds 25  drops.     M. 

SiGNA. — Rub  hands  with  preparation,  and  cover  with  gloves  at  night. 

LIQUOR  SOD^  CHLORATE— SOLUTION  OF  CHLORINATED  SODA. 
labarraque's  solution. 

Formula.— ^2£.\  NaClO. 

Derivation. — Solution  of  Chlorinated  Soda  is  obtained  by 
decomposing  a  solution  of  carbonate  of  sodium  by  one  of  chlo- 
rinated lime.  It  is  a  transparent  liquid,  of  a  greenish-yellow 
color,  having  a  faint  odor  of  chlorine  and  a  sharp  saline  taste. 

Medical  Properties  and  Action. — Solution  of  chlorinated  soda 
internally  is  stimulant,  tonic  and  antiseptic.  Externally  it  is  a 
stimulant,  astringent  and  deodorizer,  and  is  generally  applied  in 
the  form  of  a  lotion. 

Therapeutic  Uses. — Solution  of  chlorinated  soda  is  employed 
internally  in  typhus  and  typhoid  and  malignant  scarlet  fevers, 
mesenteric  affections  of  children,  etc.  Externally  it  is  used  as  an 
application  to  all  forms  of  foul  and  indolent  ulcers,  ulcerations  of 
membrane,  ozaena,  coryza,  otorrhoea,  syphilitic  eruptions  of  scalp 
and  other  skin  diseases,  burns,  etc.,  etc.  It  is  used  diluted  and 
has  an  alkaline  reaction.  It  is  a  powerful  disinfectant,  and  is 
useful  in  all  affections  attended  with  fetor.  The  concentrated 
solution  is  an  irritant  poison  and  caustic ;  largely  diluted  it  is 
tonic  and  stimulant. 

Dose. — A  solution  of  chlorinated  soda,  gtt.  xxx  to  oj,  diluted, 
several  times  a  day;  it  fulfills  the  same  indications  as  chlorinated 
lime. 

Dental  Uses. — Solution  of  chlorinated  soda  is  a  valuable  agent 
in  dental  practice  as  a  disinfectant,  deodorizer  and  antiseptic.  It 
is  employed  in  mercurial  stomatitis,  ulcerated  gums,  fetid  dis- 
charges from  carious  teeth,  and  all  affections  of  the  mouth  at- 
tended with  fetid  discharge,  and  is  useful  for  its  stimulating  prop- 


KINO— KINO. 


449 


erty,  thus  inducing  healthy  action  -,  also  in  aphthae,  cancrum 
oris,  diseases  of  the  antrum,  necrosis  of  the  bones  of  the  jaws, 
scurvy,  offensive  breath,  and  as  a  bleaching  agent  for  discolored 
teeth,  especially  in  combination  with  powdered  alum.  It  should 
be  kept  in  glass-stoppered  bottles  and  protected  from  the  light 
and  heat. 


DENTAL    FORMULA. 

For  Aphtha  and  Ulceration  of  the  lor  Mercurial  Stomatitis,  Fetid  Dis- 

Moulh  of  Children.  charges  from    Carious   Teeth,  Ulcer- 

U.     Liquor  sodee  chlor.,  ated  Gums,  Etc. 

Myrrha; aa  f ^  ss  K .     Liquor  sodse  chlor.    .  f 3  vj 

Aquae  rosae .    ...  f^^j  Aquae f^xij.    M. 

Aquae f  J  vj.     M.  SiGNA. — To  be  used  as  a  lotion. 

SiGNA. — To  be  used  as  a  lotion. 

For  Offensive  Breath  and  Deodorizer 

For  Alercurial  Stomatitis.  Generally. 

R .     Liquor  sodae  chlor.  .    .  ^  ss  R .     Liquor  sodae  chlor. 

Mellis ^ss  (concent.)    .    .    .  gtt.vj  to  x 

Aquae  destillatae    .    .    .  ^  x.     M.  Aquae  purae  .    .    .    .   5  ij.           M. 

SiGNA. — To  be  used  as  a  mouth  wash,  SiGNA. — To  be  used  as  a  gargle. 

For  Phagedenic  and  Sloughing  Ulcers.  For  Offensive  Breath. 

R.     Liquor  sodae  chlor.  .    .  f,^j  R.     Liquor  sodae  chlor.    .    .  ^j 

Aquae i'^vu].  M.  Aquae Jiv.  M. 

SiGNA. — To  be  applied  as  a  lotion.  SiGNA. — To  be  used  as  a  gargle. 


KINO— KINO. 

Source. — The  inspissated  juice  of  the  Pterocarpus  Marsupium., 
and  of  other  plants.  ^     - — 

Medical  Properties  and  Therapeutic  Uses. — With  Krameria, 
Galla,  and  Catechu,  Kino  is  one  of  the  substances  containing 
forms  of  tannic  acid,  and  has  the  same  physiological  action  and 
uses,  being  powerfully  astringent.  The  tincture,  "  Tinctures 
Kino"  composed  of  ten  parts  of  kino  to  one  hundred  parts  of 
alcohol,  is  the  only  preparation  employed. 

Dose. — Of     Tincturce     Kino.,  TTlx  to   gij.     (See    Tannic    and 
Gallic  Acids,  Krameria.) 
29 


450  DENTAL  MEDICINE. 


LITHIUM— LITHIUM. 

Source. — From  the  alkali  Lithium,  which  is  rare  in  nature. 

Preparations. — Lithii  Carbonas — carbonate  of  lithium,  a  white 
powder  but  slightly  soluble  in  water,  and  having  a  feeble  alkaline 
reaction. 

Dose. — Grs.  ij  to  grs.  x. 

Lithii  Citras. — Citrate  of  Lithium,  a  deliquescent  white  pow- 
der, soluble  in  twenty-five  parts  of  water. 

Dose. — Grs.  v  to  grs..  xxx. 

Lithii  Salicylas. — Salicylate  of  Lithium,  a  deliquescent  white 
powder  with  a  sweetish  taste,  feeble  acid  reaction  and  very  soluble 
in  alcohol  and  water. 

Dose. — Or.  v  to  9j. 

Lithii  Benzoas. — Benzoate  of  Lithium,  either  in  the  form  of 
a  white  powder,  or  small  shining  scales,  is  not  deliquescent  in 
the  air,  and  has  a  sweetish,  cooling  taste  and  a  feeble  acid  re- 
action. 

It  is  soluble  in  twelve  parts  of  alcohol  at  60°  F.,  and  in  four 
parts  of  water. 

Dose. —  Gr.  ij  to  gr.  xv. 

Medical  Properties  and  Therapeutic  Uses. — These  lithium  salts 
have  strong  alkaline  properties,  and  produce  effects  similar  to 
those  of  the  potassium  and  sodium  compounds  ;  and  hence  are 
very  effective  antacid  agents.  The  salts  of  lithium  are  employed 
with  great  benefit  in  rheumatic  gout,  uric  acid  diathesis,  rheuma- 
tism, uric  acid  calculi  of  kidneys  and  bladder,  irritable  bladder 
from  an  excess  of  acid  in  the  urine,  etc. 

Dental  Uses. — The  lithium  salts  are  effective  in  preventing  and 
correcting  the  effects  of  a  gouty  diathesis  upon  the  teeth,  and  in 
periodontitis  dependent  upon  gout.  The  carbonate  of  lithium  is 
employed  to  arrest  the  abrasion  or  erosion  of  the  teeth,  when  due 
to  an  excess  of  uric  acid  in  the  saliva;  for  such  a  purpose  the 
agent  can  be  dissolved  in  carbonic  acid  water. 

LITMUS— LACMUS. 

Source. — Litmus  is  a  peculiar  coloring  matter  obtained  from 
various    species    of  rocella,  of  the    natural    order    Lichenes — the 


LITMUS— LACMUS.  45I 


Lichen  order,  which  grow  on  Alpine  or  maritime  rocks  in  various 
parts  of  the  world.  The  varieties  used  for  chemical  purposes 
are  obtained  from  the  European  and  African  coasts  and  Northern 
Europe.  They  yield  coloring  substances  by  the  reaction  of 
water,  air,  and  ammonia.  Litmus  is  prepared  chiefly  in  Hol- 
land ;  the  lichens  are  coarsely  powdered  and  macerated  for 
several  weeks,  with  occasional  agitation  in  a  mixture  of  urine, 
lime  and  potassa  or  soda,  fermentation  ensuing;  the  mass  be- 
comes first  red  and  ultimately  blue,  and  is  then  mixed  with  cal- 
careous or  siliceous  matter,  to  give  it  consistence.  A  tincture  is 
formed  from  this  product  (litmus  i  part  to  distilled  water  20 
parts),  and  blue  litmus  paper  is  made  by  steeping  unsized  paper 
in  the  liquid  and  afterward  drying  it.  The  blue  tincture  is  ren- 
dered deeper  in  color  by  indigo.  Red  litmus  paper  is  prepared  in 
the  same  manner,  except  that  the  tincture,  into  which  the  unsized 
paper  is  steeped,  is  reddened  by  the  addition  of  sulphuric  acid. 

Dose. — The  chief  use  of  litmus  in  medicine  and  dentistry  is  as 
a  test  of  acids  and  alkalies  ;  blue  litmus  paper  being  turned  red  by 
acids,  while  red  litmus  paper  is  turned  blue  by  alkalies.  In  dental 
practice  litmus  paper  is  employed  to  determine  the  nature  of  the 
oral  fluids — whether  acid  or  alkaline. 

A  single  color,  viz.,  purple,  has  recently  been  substituted  for 
the  ordinary  blue  and  red  litmus  paper.  This  purple  litmus  paper 
turns  red  with  acids,  blue  with  alkalies.  It  is  claimed  to  be  much 
more  delicate  and  convenient. 

LORETIN— META-IODO-ORTHO-OXYQUINOLINE    AND     SUL- 
PHONIC    ACID. 

Loretin  is  a  new  succedanum  for  iodoform,  and  is  in  the  form 
of  a  beautiful  yellow  crystalline  powder,  which  resembles  iodo- 
form in  appearance,  but  is  free  from  objectionable  odor,  and  does 
not  produce  an  artificial  eczema,  two  drawbacks  to  the  use  of 
iodoform,  as  loretin  is  completely  odorless. 

In  water  and  alcohol,  loretin  is  only  slightly  soluble,  in  ether 
and  oils  practically  insoluble,  but  with  oily  liquids  and  especially 
with  collodion,  it  forms  emulsions  which  are  excellently  adapted 
for  many  purposes. 


452  DENTAL  MEDICINE. 


Therapeutic  Uses. — Loretin  is  non-poisonous,  and  is  equally 
well  adapted,  especially  when  mixed  with  a  small  proportion  of 
calcined  magnesia,  as  a  dusting  powder  for  the  surface  of  wounds 
and  for  insufflating  into  hollows  and  cavities.  Bacteriological 
experiments  by  Ammelburg,  have  demonstrated  the  power  of 
loretin  as  a  germicide  as  well  as  an  antiseptic. 

In  the  treatment  of  wounds,  the  surface  is  kept  clean  with  dry 
sterilized  pads  of  gauze,  and  then  closed  with  the  needle.  A 
bandage  with  lumps  of  surgical  wadding  and  loretin  collodion  is 
then  laid  upon  the  closed  wound.  Cavities  are  dusted  with  loretin 
powder,  or  a  tampon  of  loretin  gauze  is  introduced  ;  a  small 
pencil  of  loretin  is  laid  in  punctured  wounds. 

The  healing  of  the  wound  is  usually  unaccompanied  by  anv 
fever  and  progress  without  festering.  There  is  an  absence  of  any 
irritating  effect  on  the  skin,  and  persistent  eczema  has  been  cured 
by  this  agent ;  it  is  also  employed  in  empyema  of  the  pleural 
cavity  and  purulent  cystitis. 

Dental  Uses. — In  dental  practice  loretin  may  be  employed  in 
all  cases  requiring  the  application  of  antiseptics  and  germicides,  as 
a  substitute  for  iodoform  (for  the  dental  uses  of  which  see  page 
430)  and  without  the  disadvantages  of  the  latter  agent. 

LYSOL. 

Derivation. — Lysol  is  obtained  by  boiling  coal  tar  with  fat, 
alkali,  resinous  acid  and  resin,  and  contains  no  phenol,  but  prin- 
cipally cresol.  It  is  readily  soluble  in  water,  and  has  a  strong 
pungent  odor.  It  is  of  the  consistency  of  soft  or  potash  soap,  or 
in  the  form  of  a  clear  oily  liquid. 

Lysol  is  a  very  complex  substance  (not  homogeneous),  without 
any  definite  formula. 

Medical  Properties  and  Therapeutic  Uses. — It  is  claimed  that 
lysol  is  superior  as  a  germicide  to  carbolic  acid,  iodoform  and 
creolin,  its  bactericide  properties  being  very  great.  As  an  anti- 
septic, etc.,  in  the  treatment  of  wounds  a  i  per  cent,  solution  is 
employed ;  for  internal  washings  y^  per  cent,  solutions  are 
recommended.  It  sometimes  exerts  an  irritant  action  on  the 
skin. 


LYSOL.  453 

Dr.  F.  Haenel  lays  special  stress  upon  the  simplicity  of  its  use 
— a  few  minutes  energetic  brushing  with  the  solution  being  all 
that  is  required  to  prepare  a  surface  for  operation,  instead  of  the 
usually  complicated  process  of  cleaning  and  disinfecting  the 
skin.  For  this  purpose  lysol  answers  as  well  as  the  best  soap, 
removing  not  only  visible  dirt,  but  fatty  or  resinous  spots  on  the 
skin,  instruments,  etc.  The  soapy  feeling  it  imparts  to  the  hands, 
instruments  and  sutures,  is  best  avoided  by  drying  the  hands  and 
the  prepared  area  of  operation  with  a  sterilized  cloth  before  be- 
ginning to  operate. 

With  respect  to  the  bactericidal  properties  of  the  preparation, 
Schotellius  found  that  in  15  to  20  minutes  a  one-third  per  cent, 
solution  destroyed  all  kinds  of  germs.  The  investigations  of 
Gerlach  led  to  similar  results,  and  the  experiences  of  Dr.  F. 
Haenel  are  also  in  accordance  with  these  statements.  He  used 
solutions  varying  in  strength  from  j4  to  y^  per  cent.,  and  on  all 
grounds  concludes  that  Lysol  is  superior  to  sublimate,  carbolic 
acid,  iodoform,  and  the  other  ordinary  antiseptics,  either  by  virtue 
of  its  non-poisonousness,  or  odorlessness,  or  the  clearness  of  its 
solutions.  It  forms,  he  points  out,  clear  mixtures  with  distilled 
water,  or  with  ordinary  water  which  does  not  contain  much 
chalk.  In  solutions  made  with  spring  or  tap  water  which  contains 
much  lime,  a  turbidity  appears  which  increases  in  the  progress  of 
time,  and  is  less  conspicuous  in  strong  than  in  weak  solutions. 
As  the  disinfectant  constituents  remain  in  solution,  the  bacter- 
icidal action  of  the  liquid  is  no  way  prejudiced.  For  some  pur- 
poses this  turbidity  is  a  disadvantage,  however,  and  the  author 
states  that  the  best  way  to  avoid  it,  is  to  prepare  the  solutions 
immediately  before  use,  if  necessary,. to  avoid  the  employment  of 
the  weaker  dilutions. 

Dental  Uses. — Lysol  may  be  employed  in  dental  practice  as  an 
antiseptic,  disinfectant,  and  germicide  in  the  case  of  putrescent  or 
gangrenous  pulps,  to  disinfect  root-canals  and  carious  cavities  of 
teeth  ;  also  in  the  form  of  a  I  per  cent,  solution  for  unhealthy 
wounds  and  ulcers  of  the  oral  mucous  membrane,  upon  which  it 
has  an  astringent  effect.  It  is  advisable  to  employ  lysol  in  from 
1/^  to   I   per  cent,  solution  whenever  an  antiseptic  or  aseptic  in- 


454  DENTAL  MEDICINE. 


jection  is  desired,  and  in   i   to  2  per  cent,  solution  for  dressing 
wounds  and  sterilizing  instruments  and  also  the  hands. 


DENTAL    FORMULA. 

Mouth  Wash. 

R.        Lysol ^ss 

Aquae ^xvj.        M. 

For  Alveolar  Pyorrhoea, 
Dr.  F.  T,  Van  Woert. 

R.        Lysol f^ij 

Tinct.  capsicum gtt.  xv 

Tinct.  Iodine f  5  j.  M. 

SiGNA. — Five  drops  in  one-half  glass  of  water  used  as  a  wash  in 
cleansing  teeth  with  a  brush. 

MAGNESIA— CALCINED  MAGNESIA. 

Formula. — MgO. 

Derivation. — Magnesia  is  obtained  by  exposing  carbonate  of 
magnesium  to  a  red  heat,  and  thus  expelling  all  of  the  car- 
bonic acid,  which  is  shown  by  a  want  of  effervescence  on  the 
addition  of  dilute  sulphuric  acid.  It  is  very  light,  and  of  a  white 
color  and  odorless,  and  in  the  form  of  powder,  with  an  earthy 
taste,  and  slightly  soluble  in  water,  more  so  in  cold  than  in  hot 
water. 

Medical  Properties  and  Action. — Magnesia  is  antacid  and  laxa- 
tive, its  laxative  effect  being  the  result  of  the  combination  it  forms 
with  the  three  acids  of  the  stomach  and  intestines.  After  its 
effects  are  exerted  in  the  intestinal  canal,  it  becomes  absorbed 
and  renders  the  urine  alkaline.  Large  doses,  when  administered 
for  a  considerable  time,  may  accumulate  in  the  bowels ;  such  an 
effect  may  be  avoided  by  administering  it  with  lemonade,  which 
renders  it  more  soluble.  Being  mild  and  unirritating,  it  is  well 
adapted  for  children,  and  is  an  excellent  remedy  for  great  acidity 
in  the  stomach.  It  is  the  antidote  for  poisoning  by  the  mineral 
acids. 


CALCINED  MAGNESIA.  455 

Therapeutic  Uses. — Magnesia  is  administered  in  acidity  of  the 
stomach,  heartburn,  sick  headache  and  kidney  affections,  as  an 
antacid,  and  in  combination  with  other  agents  in  the  diarrhoea  of 
children.     It  is  also  an  efficient  aperient,  alone  or  in  a  little  milk. 

Dose. — Of  magnesia,  as  a  laxative,  gr.  x  to  5j  ;  as  an  antacid, 
3j.  Of  a  preparation  known  as  "  Henry's,"  the  dose  is  half  the 
quantity  just  given. 

Dental  Uses. — Magnesia  is  employed  in  dental  practice,  chiefly 
for  its  antacid  properties,  as  an  ingredient  of  dentifrices ;  in  solu- 
tion in  the  form  of  a  gargle,  to  counteract  the  effect  of  acid  medi- 
cines upon  the  teeth ;  also  as  an  ingredient  of  remedies  for  infantile 
diarrhoea  during  the  period  of  dentition ;  and  also  to  change  an 
acid  condition  of  the  oral  fluids,  by  being  rubbed  between  the 
teeth  and  permitted  to  remain  for  a  short  time. 

Magnesium  Hydrate. — Dr.  E.  C.  Kirk  recommends  Phillips' 
Milk  of  Magnesia,  which  consists  of  precipitated  magnesium  hy- 
drate held  in  suspension  in  water,  for  contracting  the  injurious 
action  of  acid  secretions,  especially  in  erosion  cases.  It  is  applied 
in  the  same  way  that  lime-water  or  precipitated  chalk  is  used  for 
the  purpose  of  bringing  about  an  alkaline  condition  of  the  oral 
fluids,  by  neutralizing  the  excess  of  acids  present.  A  teaspoonful 
of  the  preparation  taken  into  the  mouth  and  allowed  to  float 
around  over  the  teeth  coats  them  with  a  slight  film  of  magnesium 
hydrate,  which  protects  the  tooth-surface  from  the  acid  action  for 
a  number  of  hours.  It  should  be  used  three  times  daily,  after 
meals,  and  for  erosion,  night  and  morning. 

DENTAL    FORMULA. 
I^or   Infantile  Bilious  Diarrhcea. 

CONDIE. 

R.    Magnesia  calc.  .    .    .  gr.xxiv 

Calomel gr-ij-iij 

Ipecacuanha  ....  gr.ij-iij 

Ext.  hyoscyami  .    .    .  gr.iv-vj.  M.  Aq.  cinnamon  .    .    .    .  Jiij.      M. 

F.  ch.  No.  xij.                                    •  SiGNA. — A    teaspoonful  every   2  or  3 

hours;  each  dose  to  be  followed  in 

SiGNA. — One  to  be  given  every  2  or  3  the  course  of  an  hour  by  the  fifth  of 

hours.  a  grain  of  Dover's  Powder. 


For  Infantile  Mucous  Diarrhoea, 

Eherle. 

.    Magnesise   calc.  .    . 

.gr.x 

Bals.  copaibse      .    . 

■  5J 

Spir.  aether  nit.    .    . 

•  3  "J 

Sacch.  alb 

•  3y 

Aq.  cinnamon  .    .    . 

•  JiiJ- 

456  DENTAL  MEDICINE. 


MAGNESII  SULPHAS— SULPHATE  OF   MAGNESIUM. 
(epsom  salt.) 

Formula.— MgS0,7H.,0. 

Derivation. — Epsom  Salt  is  obtained  by  the  action  of  sulphuric 
acid  on  magnesite,  the  siliceous  hydrate  of  magnesium.  It  is  in 
the  form  of  small,  colorless  crystals,  which  effloresce  on  exposure 
to  the  air,  and  are  very  soluble  in  water.  It  is  odorless,  but  has 
a  very  bitter  taste. 

Medical  Properties  and  Action. — Sulphate  of  magnesia  is  a  re- 
frigerant purgative,  safe  and  mild  in  its  action,  and  is  perhaps 
more  commonly  employed  as  a  cathartic  than  any  other.  It  is  at 
times  combined  with  other  agents. 

Therapeutic  Uses. — Sulphate  of  magnesia  is  administered  as  a 
saline  purgative  in  acute  inflammatory  and  febrile  affections,  to 
depress  the  arterial  tension,  and  also  to  relieve  the  kidneys  when 
they  are  hyperaemic ;  hence  it  is  a  valuable  remedy  in  renal  and 
cardiac  dropsy,  constipation  of  lead  colic,  acute  dysentery,  dys- 
pepsia with  constipation,  etc.,  etc. 

Dose. — Of  sulphate  of  magnesia,  5j  to  5j?  in  water  or  carbonic 
acid  water. 

Dental  Uses. — Sulphate  of  magnesia  is  employed  internally  in 
dental  practice,  to  reduce  the  arterial  tension  in  acute  inflam- 
mations of  the  dental  organs,  such  as  acute  pulpitis,  acute  perio- 
dontitis, etc. 

To  disguise  the  bitter  taste  of  Epsom  salts,  the  following  for- 
mula may  be  employed  : — 

R.         Maganesii  sulphatis ^y 

Essentise  menthse gtt.iij.  M. 

DENTAL    FORMULA. 
/■"or  Dystiria  of  Difficult  Dentition, 

R.         Sulpli.  magnes ^ij  to  jiij 

Aquae  purse ^j  dein  adde 

Spin  asther.  nitrici "T^K] 

Tinct.  opii Hlvij  to  xv.    M, 

SiGNA A  teaspoonful,  to  be  repeated  according  to  circumstances. 


MATICO.  457 

MATICO. 
Source. — Matico — maticce  fol'ne — are  the  dried  leaves  of  the 
shrub  artanthe  elongata,  of  the  natural  order  Piperacece — pepper 
order,  and  is  a  native  of  Peru.  They  are  from  two  to  eight  inches 
long  by  an  inch  in  breadth,  strongly  reticulated,  and  of  a  bright 
green  on  the  upper  surface  and  lighter  in  color  beneath  when 
fresh,  with  an  agreeable  aromatic  odor  and  a  strong  astringent 
taste.  They  contain  a  trace  of  tannic  acid,  a  peculiar  acid, 
artanth'ic^  a  volatile  oil,  resin,  and  a  very  bitter  principle — 
maticin. 

Medical  Properties  and  Action. — Matico  is  an  aromatic  tonic, 
an  alterative  stimulant,  an  internal  hemostatic  and  local  styptic. 
It  has  a  special  determination  to  the  mucous  membranes,  and  al- 
though as  an  internal  remedy  its  astringent  properties  are  not  so 
well  marked,  it  acts  externally  as  a  reliable  hemostatic  and  styp- 
tic. The  powder  made  from  the  underside  of  the  leaf  is  more 
powerfully  styptic  than  that  from  the  upper  side. 

Therapeutic  Uses. — Matico  in  the  form  of  powder,  infusion  and 
fluid  extract,  is  employed  in  internal  hemorrhages,  epistaxis, 
atonic  diarrhoea  and  diseases  of  the  urinary  passages,  etc.;  exter- 
nallv  as  a  hemostatic  in  superficial  hemorrhages,  and  also  in 
leucorrhoea,  in  the  form  of  an  injection. 

Dose. — Of  powdered  matico,  5ss  to  ojj  three  times  a  day ;  of 
the  infusion  the  dose  is  f^'j ;  of  the  fluid  extract  the  dose  is  f5ss 
to  f.5j. 

Dental  Uses. — The  powder  and  tincture  are  valuable  styptics  in 
hemorrhage  following  the  extraction  of  teeth,  hemorrhage  from 
leech  bites  and  superficial  wounds  of  mucous  membrane. 

MEDITRINA. 

Meditrina  is  sea-water  charged  with  electricity.  It  possesses 
antiseptic  and  deodorant  properties.  It  is  claimed  that  meditrina 
enters  chemically  into  combination  with  the  mephitic  odors  and 
gases,  and  in  this  way  causes  their  destruction.  Although  it  is 
not  as  powerful  an  antiseptic  as  many  other  agents  of  this  class, 
there  is  no  doubt  of  its  being  an  excellent  deodorant. 


458  DENTAL  MEDICINE. 


Dental  Uses. — It  has  been  recommended  as  useful  in  putres- 
cent pulp-canals,  alveolar  pyorrhoea  and  stomatitis,  as  a  mouth 
wash,  and  in  all  offensive  conditions  of  the  oral  cavity. 

MENTHOL— JAPANESE  CAMPHOR. 

(peppermint  camphor.) 

Formula. — CiqHjqO. 

Derivation. — Menthol  is  the  stearoptene  of  peppermint  oil,  and 
is  obtained  from  this  oil  either  by  long  keeping  or  by  being  cooled 
at  a  low  temperature.  Chemically,  menthol  occupies  the  posi- 
tion of  an  alcohol,  having  in  its  composition  four  atoms  more  of 
hydrogen  than  the  ordinary  camphor,  and  containing  the  radical 
menthyl.  It  is  in  the  form  of  a  crystalline  solid,  composed  of 
small  white  crystals  of  a  peppermint  odor  and  resembling  sul- 
phate of  magnesia.  It  is  imported  as  Japanese  camphor,  its  chief 
source  being  the  Japanese  and  Chinese  peppermint  oils.  In  a 
liquid  state  it  has  a  specific  gravity  less  than  that  of  water.  It  is 
rendered  liquid  and  volatile  at  a  temperature  one  or  two  degrees 
below  that  of  the  body.  It  is  sparingly  soluble  in  cold  water, 
liquefying  slowly  in  water  at  82°  F.,  quickly  at  120°  F.,  but 
remains  mostly  as  a  separate  body.  It  is  freely  soluble  in  alco- 
hol, ether,  glycerine  and  in  the  fixed  and  volatile  oils. 

Medical  Properties  and  Action. — Menthol  is  anodyne,  anti- 
spasmodic, and  antiseptic.  In  doses  of  gr.  ^^  to  I  it  steadies  the 
contractions  of  an  excited  heart,  and  causes  tranquillity,  and  at 
the  same  time  slight  cerebral  drowsiness. 

Half  a  grain  may  cause  vomiting  from  gastric  irritation,  hence 
care  should  be  observed  in  its  administration,  either  internally  or 
externally  about  the  mouth.  Its  internal  use  is  not  advocated, 
unless  well  diluted,  but  its  principal  use  is  as  an  external  applica- 
tion. 

Therapeutic  Uses. — Menthol  is  said  to  prove  as  effectual  as 
aconite,  veratria  and  atropine  for  such  diseases  as  neuralgia,  bra- 
chalgia  and  gout ;  more  so  it  is  claimed  by  some.  It  is  also  used 
in  chronic  rheumatism  and  in  headache.  It  is  also  applied  in 
putrefactive  wounds,  as  an  antiseptic. 


MENTHOL. 


459 


Dental  Uses. — In  dental  practice,  menthol  has  given  satisfac- 
tion as  an  external  remedy  in  facial  neuralgia,  odontalgia,  as  an 
obtunder  of  sensitive  dentine,  and  as  a  local  anaesthetic.  For  re- 
lieving the  pain  of  sensitive  dentine,  a  small  portion  of  the  crys- 
tals is  applied  to  the  sensitive  surface,  and  in  a  feu'  minutes  the 
local  anaesthetic  effect  is  produced.  As  an  antiseptic  it  has  been 
employed  in  the  treatment  of  decomposing  pulps  of  teeth, 
necrosed  teeth,  etc.  When  applied  to  mucous  surfaces  for  its 
anaesthetic  effect,  a  twenty  to  thirty  per  cent,  solution  is  used, 
but  it  is  more  evanescent  than  cocaine.  Menthol  also  forms  an 
ingredient  of  a  devitalizing  mixture. 

The  oil  of  the  ordinary  peppermint  is  considered  to  be  a  germi- 
cide and  antiseptic  of  considerable  power  and  rapidity.  It  is 
readily  diffusible,  does  not  evaporate  quickly,  and  is  non-poison- 
ous. It  is  useful  in  root-canals  and  fistulous  tracts  after  removal 
of  pulps,  and  for  hypersensitive  dentine. 


DENTAL    FORMULi^. 


For  Facial  Neuralgia  and  Odontalgia. 

R .     Mentholi gr.j 

Spts.  vini    rectificati    .  X(\] 
Olei  caryophylh    .    .    .  lTl,x.    M. 
SiGNA. — For  facial   neuralgia,  painted 
on   the    affected  part.     For  odontal- 
gia,  applied  on   cotton    to    carious 
cavity. 

For  Neuralgia  and  Odontalgia. 

R .     Mentholi gr.v 

Olei   caryophylli  (or  oil 

of  cajeput)    ....  fjj.      M. 
SiGNA. — To   be   painted     on    affected 
part,  or,  for   odontalgia,  applied   on 
cotton. 

Local  AncEsthetic. 
For  Abscesses,  Boils,  Felons,  etc. 

R .     Chloroformi 3  v 

Ether  sulphurici    .    .    .   ^j 

Mentholi ^ss.  M. 

SiGNA. — Use  with  spray  apparatus. 


For  Odontalgia. 

R .     Mentholi gr-xv 

Cocaine  hydrochlor.  gr.xv 

Pul.  opii ^j 

Mucilag.  acacise, 

Pulv.  altheas  .  .,  .  aa  q.  s.  M. 
SiGNA. — Introduce  on  a  pledget  of 
cotton. 


For  Odontalgia. 


R 


M. 


Mentholi    ....    5  parts 
Chloroformi  ...    8  parts. 
SiGNA. — Apply  on  cotton. 

Local  Anastketic. 
Dr.  a.  W.  Harlan. 

R  .  Mentholi  ...  2  parts 
Ether  ....  15  parts 
Chloroformi    .    lOO  parts.         M. 

Signa. — For   injection,  or   applied  on 
cotton  about  tooth. 


460  DENTAL  MEDICINE. 


For  Odotitalgia. 
Dr.  Schaeffer. 

R .     Phenol  crystals I  part 

Mentboli 3  parts. 

Melt  over  a  moderate  heat. 
SiGNA. — Apply  to  inflamed  pulp. 

METHYLENE— BICHLORIDE  OF  METHYLENE. 

Formula. — C  Hg.  Clj. 

Derivation. — Methylene  is  obtained  by  the  action  on  chloro- 
form of  nascent  hydrogen.  It  boils  at  104°  F.  and  40°  C,  and 
is  a  colorless,  volatile  liquid  with  the  odor  of  chloroform.  It  was 
introduced  in  1840  by  Dr.  B.  W.  Richardson.  It  is  pleasant  to 
inhale  in  the  form  of  vapor.  Its  specific  gravity  is  1.344,  and 
evaporates  more  easily  than  chloroform,  and,  the  vapor  being 
denser,  it  requires  a  less  quantity  than  ether.  It  is  soluble  in 
alcohol  and  ether,  and  is  frequently  combined  with  other  agents 
to  lessen  its  cost. 

Medical  Properties  and  Therapeutic  Uses. — Methylene  possesses 
many  of  the  dangerous  qualities  of  chloroform  when  used  as  a 
general  anaesthetic,  and  death  results  from  syncope  with  dilated 
pupils.  It  was  a  favorite  anaesthetic  with  Dr.  Richardson,  and 
Sir  Spencer  Wells  believes  that  it  has  all  the  advantages  of  com- 
plete anaesthesia  with  fewer  drawbacks  than  any  other.  He 
gives  it  diluted  with  air  by  Junker's  apparatus,  and  it  is  supposed 
that  he  employs  a  mixture  of  methylic  alcohol  and  chloroform. 

Despite  the  fact  that  so  eminent  a  surgeon  as  Sir  T.  Spencer 
Wells  uses  methylene  as  an  anaesthetic,  and  has  continued  to  ad- 
vocate its  use  for  twenty  years,  very  few  have  followed  his  ex- 
ample. This  is  because  the  statistics  of  mortality  from  this 
anaesthetic  apparently  show  it  to  be  considerably  more  dangerous 
than  ether.  Like  chloroform  it  destroys  life  by  its  effects  upon 
the  heart. 

METHYLIC  ETHER— METHYL-ETHYLIC  ETHER. 
Formula. — (C  113)20. 

Derivation. — Methylic  Ether  is  obtained  by  digesting  methylic 
alcohol  with  strong  sulphuric  acid.     It  is  a  gaseous  substance,  of 


MICRODINE. 


461 


an  ethereal  odor,  and  under  the  name  of  methyl-ethylic  ether^  it 
has  been  used  as  a  general  anaesthetic.  The  methylic  ether  is 
prepared  for  use  as  methyl-ethylic  ether  by  frequent  washings  in 
a  strong  solution  of  potassa,  and  is  afterwards  dissolved  in  abso- 
lute ethylic  ether.  In  order  that  it  may  be  fit  for  use,  it  is 
necessary  to  keep  it  for  some  time  securely  stopped. 

Dental  Uses. — According  to  Dr.  B.  W.  Richardson,  of  Eng- 
land, methylic  ether  is  a  superior  anaesthetic  for  dental  operations 
— better,  he  says,  than  nitrous  oxide  gas,  because  it  allows  air  to 
be  given  with  it,  and  does  not  asphyxiate  nor  produce  muscular 
spasms  and  syncope.  Under  its  influence,  the  patient  is  in  a 
state  of  semi-consciousness,  but  is  not  conscious  of  pain  from 
an  operation. 

MICROCIDIN— MICROCIDINE. 

Derivation. — Microcidin  is  a  combination  of  naphthol  and 
soda.  Naphthol  25  per  cent,  and  sodium  naphtholate  75  per 
cent.,  one  part  being  soluble  in  three  parts  of  water.  Micro- 
cidine  does  not  corrode  instruments  or  dressing  materials,  and  is 
without  odor  or  taste. 

Medical  Properties  and  Therapeutic  Uses. — Microcidin  has  a 
very  feeble  toxicity,  is  caustic  in  large  quantities,  but  in  me- 
dicinal doses, 'even  the  largest  required,  is  not  irritating  when  ap- 
plied to  wounds  as  an  antiseptic  and  disinfectant ;  it  may  also  be 
used  for  toilet  purposes.  It  reduces  fever  rapidly,  and  is  excreted 
by  the  urine,  which  is  rendered  aseptic.  It  has  been  employed 
successfully  in  a  large  number  of  cases  of  infected  and  operative 
wounds.  It  is  used  in  aqueous  solution  in  the  strength  of  5  to 
1000  (strong  solution)  and  3  to  lOOO. 

Dental  Uses. — As  an  antiseptic  and  disinfectant,  microcidin 
may  be  employed  in  dental  practice  on  gangrenous  pulps,  carious 
cavities  in  pulp  canals,  and  wounds  and  ulcers  of  mucous  mem- 
brane ;  and  as  a  disinfectant  and  antiseptic  generally. 

MORPHIN  A- MORPHINE. 
Formula.— C^.H^.'NO.-hH^O. 

Derivation. — Morphine  is  the  alkaloid  which  constitutes  the 
chief  narcotic   principle  of  opium,  the   proportion  varying   from 


462  DENTAL  MEDICINE. 


10  to  15  per  cent.  It  is  present  in  opium  in  combination  with 
meconic  acid,  and  the  meconate  of  morphia  is  separated  by  re- 
peated macerations  with  water,  after  which  the  salt  is  decom- 
posed by  alcohol  and  water  of  ammonia,  the  latter  precipitating 
the  morphine  and  the  former  taking  up  the  coloring  matter  as 
soon  as  it  is  freed  from  the  alkali.  The  crystals  of  morphine 
are  then  boiled  in  alcohol  and  the  solution  filtered  through  ani- 
mal charcoal.  Morphine  is  in  the  form  of  white,  or  colorless 
crystals,  which  are  inflammable  and  freely  soluble  in  boiling 
alcohol,  scarcely  soluble  in  cold  water,  and  somewhat  so  in  boil- 
ing water.  The  salts  of  morphine,  however,  are  freely  soluble 
in  water.  It  is  without  odor,  and  has  a  very  bitter  taste.  Mor- 
phine differs  somewhat  in  its  mode  of  action  from  opium,  which 
may  arise  from  the  peculiar  state  of  combination  in  which  it  ex- 
ists in  opium.  Morphine  is  more  insoluble  than  its  salts,  and  for 
this  reason  the  latter  are  preferred  for  administration. 

Medical  Properties  and  Action. — Morphine  is  more  powerful 
than  opium  ;  but  it  causes  less  vascular  and  arterial  excitement, 
less  headache  and  vertigo,  less  subsequent  depression,  less  con- 
stipation, and  often  it  will  be  retained  on  an  irritable  stomach, 
when  opium  or  its  tincture  (laudanum)  would  be  rejected. 

Morphine  is  indicated  when  the  object  is  to  relieve  nervous 
irritability  and  induce  tranquillity.  The  effects  of  morphine 
differ  according  to  the  peculiarities  of  nervous  constitution. 
The  hypnotic  effect  may  be  produced  and  the  stimulant  action 
be  confined  to  the  heart ;  in  some  cases  the  excitant  effect  pre- 
vails, or  the  two  effects  may  be  equal.  The  excitant  effect  may 
counteract  the  hypnotic  effect  to  a  greater  or  less  degree,  result- 
ing in  insomnia  with  restlessness,  or  even  delirium.  Females 
appear  to  be  more  liable  to  its  excitant  effects  than  males;  and 
if  there '  is  present  a  highly  emotional,  excitable  and  energetic 
temperament,  it  causes  great  distress  and  dangerous  effects  when 
hypodermically  administered. 

Therapeutic  Uses. — Morphine,  in  the  form  of  salts,  is  em- 
ployed as  an  anodyne  and  hypnotic  in  neuralgic  affections,  dis- 
eases of  the  heart,  painful  uterine  affections,  and  in  all  cases  of 
painful  affections.     (See  Opium.) 


MORPHINE.  463 


The  principal  salts  of  morphine  are  the  acetate,  the  hydro- 
chlorate  and  the  sulphate. 

MORPHINE  ACETAS ACETATE  OF  MORPHINE. 

Formula.— C,,HigNO.,,CMi02+3H^O. 

Derivation. — Acetate  of  Morphine  is  obtained  by  precipitating 
morphine  from  the  hydrochlorate  of  morphine,  by  the  aid  of  am- 
monia, the  precipitate  resulting  being  washed  in  distilled  water 
and  dissolved  and  neutralized  by  acetic  acid,  after  which  it  is 
evaporated  and  dried  by  heat.  It  is  in  the  form  of  a  white  or 
yellowish-white,  amorphous  or  crystalline  powder,  altogether 
soluble  in  water  and  alcohol,  and  of  a  bitter  taste. 

MORPHINE      HYDROCHLORAS     OR     MURIAS — HYDROCHLORATE    OR 
MURIATE     OF    MORPHINE. 

Formula.— C.^^^^O^,  HCI  +  sH^O. 

Derivation. — Hydrochlorate  or  Muriate  of  Morphine  is  ob- 
tained by  macerating  opium  in  distilled  water,  evaporating  to  a 
small  quantity,  and  adding  chloride  of  lime,  and  concentrating 
the  solution  until  it  becomes  solid  when  cool,  after  which  it  is 
pressed,  washed  with  distilled  water,  again  evaporated,  cooled 
and  pressed,  and  again  dissolved  in  distilled  water,  when  it  is  sub- 
jected to  animal  charcoal,  to  remove  the  coloring  matter,  filtered 
and  precipitated  by  ammonia,  the  codeia  of  the  opium  remaining 
in  solution.  The  crystals  resulting  are  then  dissolved  in  muriatic 
acid,  and  the  morphine  allowed  to  crystallize  into  hydrochlorate 
or  muriate  of  morphine.  It  is  in  the  form  of  snow-white, 
feathery,  flexible  and  acicular  crystals  of  a  bitter  taste  and  silky 
lustre,  and  altogether  soluble  in  water  and  alcohol. 

MORPHINE    SULPHAS — SULPHATE    OF    MORPHINE. 

Derivation. — Sulphate  of  Morphine  is  obtained  by  dissolving 
morphine  in  boiling  alcohol,  and  saturating  it  while  hot  with  sul- 
phuric acid,  the  coloring  matter  being  removed  by  animal  char- 
coal ;   it    is   then   boiled  and  filtered  while  at  the  boiling  tempera- 


464:  DENTAL  MEDICINE. 


ture.  Upon  cooling  the  sulphate  is  deposited  in  the  form  of 
white,  feathery,  acicular  crystals,  of  a  silky  lustre,  odorless,  with 
a  bitter  taste  and  a  neutral  reaction.  It  is  soluble  in  water  and 
alcohol. 

Medical  Properties  and  Action  of  the  Salts  of  Morphine. — The 
salts  of  morphine  possess  anodyne,  hypnotic  and  antispasmodic 
properties,  and  are  less  stimulating,  less  convulsant,  and  more 
hypnotic  and  anodyne  than  opium,  and  they  also  produce  less 
constipation,  and  less  diaphoretic  action  than  opium.  After  the 
administration  or  insertion  of  the  ordinary  dose,  which  is  one- 
sixth  to  one-fourth  of  a  grain,  there  is  experienced  a  sense  of 
heat  and  flushing  of  the  face,  which  may  be  preceded  by  some 
pallor,  a  fulness  of  the  head,  giddiness,  noise  in  the  ears,  and 
frequently  nausea,  sometimes  epigastric  pain.  The  vertigo  may 
cause  a  staggering  walk  and  inability  to  maintain  an  upright  po- 
sition. Injection  of  the  conjunctiva  and  contraction  of  the 
pupils  occur  at  the  same  time  that  the  cerebral  effects  are  felt. 
The  lips  have  a  bluish  appearance,  the  mouth  and  tongue  dry, 
deglutition  is  painful  and  the  voice  becomes  husky.  During 
these  symptoms  the  anodyne  effects  are  manifested  by  the  relief 
of  pain  and  spasm,  with  perfect  calmness  of  mind  and  tranquil- 
lity. While  the  effect  is  generally  hypnotic,  yet  in  some  cases 
there  is  extreme  wakefulness,  with  great  jnental  activity,  and 
when  sleep  occurs,  instead  of  its  being  calm,  the  respirations  are 
slow,  noisy  and  labored,  the  patient  being  disturbed  by  dreams 
and  visions.  While  the  action  of  the  heart  is  diminished  in  fre- 
quency, there  is  a  considerable  rise  in  the  arterial  tension.  When 
a  hypodermic  injection  of  morphine  has  been  made,  there  is  ex- 
perienced an  itching  of  the  nose,  which  may  extend  to  the  entire 
cutaneous  surface.  The  skin,  which  is  at  first  dry,  becomes 
moist,  from  diaphoresis,  which  is  sometimes  profuse.  The  secre- 
tions of  the  mucous  surface  are  also  arrested  as  a  primary  effect. 

If  morphine  is  administered  after  a  full  meal,  its  effect  is  to 
suspend  digestion  for  some  time,  and  also  to  temporarily  arrest 
the  intestinal  movements  and  diminish  the  urinal  discharge,  and 
make  its  emission  difficult  on  account  of  the  temporary  loss  of 
contractile  power  of  the  bladder  and  of  the  ejaculatory  muscles. 


MORPHINE.  465 


When  the  narcotic  effects  of  morphine  decline,  there  is  generally 
experienced  headache,  confusion  of  mind,  anorexia  and  nausea. 
When  a  poisonous  dose  is  administered,  a  profound  state  of  nar- 
cotism quickly  ensues,  the  pulse  becomes  slow  and  feeble,  the 
respiration  slow  and  indistinct,  the  skin  cold  and  covered  with 
perspiration,  the  face  pale,  blue  and  ghastly,  the  conjunctiva 
deeply  injected,  the  pupils  greatly  contracted,  the  reflex  move- 
ments entirely  destroyed.  Half  a  grain  of  morphia  is  the  small- 
est dose  which  has  proved  fatal  to  an  adult,  but  other  cases  are 
recorded  where  one  grain  destroyed  life.  It  chiefly  affects  the 
cerebro-spinal  functions,  and  causes  death  by  paralyzing  the  res- 
piratory muscles. 

The  antidotes  in  cases  of  poisoning  are  the  stomach  pump, 
emetics,  cold  effusions,  counter-irritation,  strong  coffee,  active 
stimulants,  atropine  by  hypodermic  injection,  electro-magnetism 
and  artificial  respiration. 

Therapeutic  Uses. — The  salts  of  morphine  are  employed  in  all 
neuralgic  affections,  for  the  relief  of  pain  from  whatever  cause, 
and  to  induce  sleep ;  also  in  diseases  of  the  heart,  chronic  gas- 
tritis, delirium  tremens,  tetanus,  colic,  spasms,  dysentery,  cholera, 
cough  of  pulmonary  affections,  cerebro-spinal  meningitis,  puer- 
pural  fever,  convulsive  diseases,  vomiting,  colica  pictonum, 
diarrhoea,  diabetes,  gangrene,  etc.,  etc.  For  hypodermic  injec- 
tion, the  acetate  of  morphine  is  supposed  to  possess  some  advan- 
tages over  the  other  salts,  such  as  the  sulphate  and  muriate,  one 
of  which  is  its  greater  solubility.  Morphine  is  contra-indicated 
where  there  is  a  tendency  to  apoplexy  and  coma. 

Dose. — Of  the  salts  of  morphine,  gr.  i  to  grain  i.  One-sixth 
of  a  grain  of  either  of  the  salts  of  morphine  is  equivalent  to  a 
grain  of  opium,  or  twenty-five  drops  of  the  tincture  of  opium 
(laudanum). 

For  hypodermic  injections  the  dose  of  salts  of  morphia  is  gr. 
I  to  I.  The  use  of  morphine  hypodermically  frequently  leads  to 
the  morphine  habit,  which,  once  formed,  is  rarely  abandoned  ; 
and  which,  independent  of  its  fatal  systemic  effects,  has  very  in- 
jurious effects  upon  the  teeth— the  enamel  and  dentine  becoming 
thoroughly  disintegrated,  owing  to  the  presence  of  erosive  acids. 
30 


466  DENTAL  MEDICINE. 


For  endermic  application,  gr.  ^  to  j  of  morphine  may  be 
sprinkled  on  a  surface  (which  has  been  blistered  to  remove  the 
cuticle),  over  the  seat  of  pain  ;  but  the  hypodermic  method  is  the 
most  effectual. 

Dental  Uses. — For  dental  use  the  acetate  of  morphine  and  the 
muriate  of  morphine  are  preferable  to  the  sulphate,  on  account 
of  their  greater  solubility  and  greater  chemical  affinity  with  the 
tissues  on  which  they  are  to  act.  The  acetate  of  morphine  is 
also  preferred  to  the  other  salts  as  an  ingredient  of  nerve  paste 
for  destroying  the  vitality  of  the  pulps  of  teeth,  on  account  of  its 
chemical  and  mechanical  compatibility  with  the  pulp  tissue,  giv- 
ing relief  as  an  anodyne  when  the  sulphate  would  irritate.  Con- 
cerning the  action  of  morphine  when  combined  with  arsenious 
acid,  its  effect  is  anodyne,  modifying  the  irritant  action  of  the 
arsenic,  and  preventing  to  a  considerable  degree  the  intense  pain 
which  follows  its  application  to  vitalized  structures.  Besides  its 
use  in  devitalizing  mixtures  and  as  an  obtunder  of  sensitive 
dentine,  morphine  is  employed  for  the  temporary  relief  of  odon- 
talgia, for  such  a  purpose  being  combined  with  carbolic  acid, 
sweet  spirits  of  nitre,  oil  of  cloves  and  other  anodyne  agents. 

A  paste  made  of  acetate  of  morphine  and  creasote  (or  carbolic 
acid)  is  much  used  for  obtunding  the  sensitiveness  of  dentine.  A 
thin  paste,  made  of  acetate  of  morphine  rubbed  up  with  oil  of 
cloves,  is  an  excellent  application  for  exposed  pulps ;  also  a 
mixture  of  acetate  of  morphine,  grs.  v  ;  oil  of  cajeput,  foj ; 
applied  on  a  pledget  of  cotton.  The  latter  is  also  effective  for 
the  pain  following  tooth  extraction  ;  it  is  applied  on  cotton  in  the 
alveolar  cavity. 

For  internal  administration  in  facial  and  other  neuralgias,  mor- 
phine is  combined  with  atropine  in  the  proportion  of  atropine, 
gr.  ^i^  to  -1^  ,  morphine,  gr.  i  to  i ;  hypodermically  injected. 
Morphine  in  combination  with  carbolic  acid  is  also  employed  to 
relieve  the  pain  of  an  exposed  and  painful  pulp. 


MYRRH. 


467 


DENTAL 

For  Odontalgia. 

White. 
li.      Morphinse  acetatis  .    .  gr.xx 
Olei  caryophylli, 
Spiritus  setheris  ni- 

trosi aa^ij.    M. 

SiGNA. — Apply  on  a  pellet  of  cotton. 

For  Odonlalgia. 
R.      Morphinae  acetatis  .    .gr.xx 
Creasoti  (vel  acidi  car- 

bolici) ^ij.     M. 

SiGNA. — Apply  to  carious  cavity  on  a 
pellet  of  cotton. 

For  Devitalizing  Pulps  of  Teeth. 
U .      Morphinse  acetatis    .    .    gr.j 
Acidi  arseniosi  ....  gr.ij 

Creasoti q.s.     M. 

Fiat  niassa, 
SiGNA. — Apply  a  sufficient  quantity  to 
exposed  surface  of  pulp,  on  cotton. 
(For   other   devitalizing  mixtures 
see  Arsenious  Acid.) 


FORMUL.^:. 

For  Itching  of  Inflamed  Surfaces. 
li.      Morphinae sulph.  .    .    .  gr.vj 

Sodii  boratis g  ss 

Aquae  rosae f  3  viij.  M. 

SiGNA. — To  be  used  as  a  lotion. 

For  Abraded  Surfaces  of  Teeth. 
Dr.  a.  C.  Hugenschmidt. 
To  prevent  pain  of  friction. 
R .      Morphinae  murias  .    .    .  gr.ij 

Mur.  cocaini gr.ij 

Sodii  boras ^j 

Mellis ^j-    M. 

To  Relieve  the  Pain  Following  Ex- 
traction of  Teeth,  and  a  Local  Ances- 
thetic. 

R.      Morphinae g^^-vj 

Tincturae  aconiti, 
Chloroformi, 

Alcoholis aa'f^j.     M. 

SlGNA. — Apply   on  cotton,  or  with  an 
applicator,  as  a  local  anaesthetic. 
(See    Formulae    under   Arsenious 
Acid.) 


MYRRHA— MYRRH. 

Source. — Myrrh  is  a  gum-resinous  exudation  from  a  small, 
shrubby  tree — Balsamodendron  Myrrha,  of  the  natural  order 
Amyr'idacece.,  growing  in  Arabia,  and  the  northeastern  coast  of 
Africa.  It  is  obtained  in  the  form  of  small,  irregular  fragments 
or  tears,  or  in  larger  masses,  composed  of  agglutinated  portions. 
The  juice  exudes  spontaneously  from  the  stem  of  the  tree,  and 
concretes  upon  the  bark.  When  pure,  myrrh  is  of  a  reddish- 
yellow  or  reddish-brown  color,  translucent,  with  a  strong,  peculiar 
fragrant  odor  and  a  bitter  aromatic  taste,  brittle  and  pulverizable. 
Its  powder  is  of  a  light  yellow  color  ;  when  of  a  dark  color  it  is 
impure.  When  powdered  myrrh  is  rubbed  up  for  fifteen  minutes 
with  an  equal  weight  of  muriate  of  ammonia  and  fifteen  times  its 
weight  of  water  gradually  added,  and  it  dissolves  quickly  and 
entirely,  it  may  be  considered  pure. 


468  DENTAL  MEDICINE. 


Medical  Properties  and  Action. — Myrrh  is  stimulant,  astringent, 
expectorant  and  emmenagogue.  It  stimulates  the  digestive 
organs  and  improves  the  appetite.  In  large  doses  of  a  half  ounce, 
it  causes  a  burning  sensation  in  the  stomach,  increased  arterial 
excitement,  and  profuse  diaphoresis,  with  a  great  influence  on  the 
urinary  passages.  It  diminishes  discharges  from  mucous  mem- 
brane when  internally  administered,  and  is  a  useful  external 
application  for  relaxed  tissues. 

Therapeutic  Uses. — Myrrh  is  internally  administered  in  chronic 
catarrh,  humoral  asthma,  amenorrhoea,  chlorosis,  leucorrhoea, 
chronic  bronchitis,  etc.,  etc. ;  and  in  combination  with  chalybeates 
and  aloes  in  uterine  affections. 

Locally,  myrrh  is  applied  to  inflamed,  ulcerated  and  aphthous 
surfaces. 

Dose. — Of  powdered  myrrh,  gr.x  to  5ss,  in  pill  or  suspended 
in  water. 

Tincture  of  Myrrh. —  Tinctura  Myrrhs  (myrrh^^u'y,  alco- 
hol, Oij).  Dose. — f5ss  to  f5j-  It  is  used  internally  and  exter- 
nally. 

Dental  Uses. — Myrrh,  in  the  form  of  the  powder  and  tincture, 
is  employed  as  a  local  application  to  inflamed  ulcerated  and 
spongy  gums,  ulcerations  of  mucous  membrane  of  the  mouth  and 
throat,  in  the  form  of  a  gargle ;  also  in  alveolar  pyorrhoea, 
mercurial  stomatitis,  indolent  ulcers,  aphthous  sore  mouth  of 
children.  The  diluted  tincture  forms  a  stimulating  gargle  or 
mouth  wash,  and  the  powder  is  employed  as  an  ingredient  of 
dentifrices,  for  its  stimulating  and  astringent  properties. 

DENTAL    FORMULAE. 

Astringent  Mouth  Wash.  Macerate    for   7  days  and  filter ;  to 

,      ,          .  filtrate  add  15  ounces  of  simple  syrup. 

R.      Myrrhs   (tinct.)    .    .    .  gvj  (For  other  Mouth  Washes  and  Lo- 

Rad.  iridis ?  vj  . .              t  j      ^    t-.- 

^  \  tions  see  Index  to  Diseases,  etc.) 

Benzoim ^"J 

Cort.  cinchonas  .    .    .    .   5  iv  ^^     ValzaK's    Obtunder  and  Local 

Ext.  krameriae  .    .    .    .  ^ss  Anesthetic. 

Capsici |j  R-      P'P-   menthol    .    .    .    .    ^ij 

Spt.  rectificat.  .    .    .  Cong.j.     M.  Tincture  myrrh  .    .    .    .  g  vj 

Alcohol ^x.  M. 


MYRTOL.  469 

MYRTOL— RECTIFIED  MYRTLE  OIL. 

Derivation. — Myrtol  is  obtained  from  the  leaves  and  berries  of 
the  Myrtus  Communis  (Myrtaceae),  an  evergreen  shrub  native  of 
the  Mediterranean  countries.  It  is  a  volatile  oil  containing  various 
terpenes,  cineol,  and  a  camphor-like  substance. 

Medical  Properties  and  Therapeutic  Uses. —  Myrtol  is  a  disin- 
fectant and  antiseptic,  and  causes  no  irritation  to  the  skin.  Upon 
a  denuded  or  abraded  surface  it  causes  a  slight  burning  sensation, 
which  soon  passes  off.  It  is  claimed  that  a  9  per  cent,  solution 
of  myrtol  will  completely  arrest  the  growth  of  the  micro-organisms 
of  pus ;  and  myrtol  will  also  prevent  the  decomposition  of 
organic  matters.  Internally  myrtol  promotes  digestion,  but  large 
doses  cause  headache  and  nausea.  It  communicates  a  violet 
odor  to  the  breath  and  urine,  and  is  eliminated  from  the  system 
by  the  lungs  and  kidneys. 

Myrtol  has  been  employed  with  success  as  a  disinfectant  for 
wounds  and  ulcers  ;  also  in  cutaneous  diseases  of  a  vegetable 
parasitic  origin,  and  as  a  local  remedy  in  psoriasis.  Internally, 
myrtol  has  proved  useful  in  the  destruction  of  intestinal  worms ; 
also  in  chronic  bronchitis,  gangrene  of  lungs,  pulmonary  tuber- 
culosis, chronic  pyelitis  and  cystitis ;  also  in  passive  hemorrhage. 

Dose. —  Gr.  iv. 

Dental  Uses. — Myrtol  is  employed  in  dental  practice  as  a  dis- 
infectant of  pulp  canals  and  as  an  antiseptic  for  gangrenous  pulps, 
also  to  destroy  the  growth  of  micro-organisms  in  alveolar  ab- 
scesses, and  to  disinfect  carious  cavities  in  teeth,  and  as  a  mouth 
wash  in  inflammation  of  the  mucous  membrane,  etc.,  etc. 

NAPHTHALENE— NAPHTHALIN. 

Formula. — CjoHg. 

Derivation. — Naphthalene  may  be  obtained  by  subjecting  coal-tar 
to  a  distillation,  when  it  passes  over  the  coal  naphtha.  It  is  puri- 
fied by  subliming  it  with  charcoal,  and  is  then  in  the  form  of  a 
white  crystalline  body.  It  has  a  slightly  aromatic  taste  and  the 
odor  of  coal-tar.  While  it  has  no  poisonous  effect  on  man  and 
the  higher  animals,  it  is  destructive  to  fungi  spores,  small  insects, 
etc.     It  is  soluble  in  alcohol,  ether,  naphtha  and  the  oils,  but  in- 


470  DENTAL  MEDICINE. 


soluble  in  water.  As  an  expectorant  it  has  been  used  in  humoral 
asthma  and  in  chronic  pulmonary  catarrh,  in  doses  of  from  gr.  viii 
to  XXX,  in  syrup  or  emulsions,  and  as  an  ointment  in  skin  diseases 
of  a  scaly  nature;  also  as  a  vermifuge  in  doses  for  adults  of  gr. 
XV,  followed  immediately  by  2  ounces  of  castor  oil.  Naphthalin 
is  a  powerful  antiseptic,  and  can  be  used  as  a  substitute  for  iodo- 
form, with  the  advantage  of  not  producing  any  constitutional  ac- 
tion. Its  application  causes  a  slight  pain  of  short  duration.  As 
an  antiseptic  and  disinfectant,  it  is  applied  to  indolent  ulcers, 
septic  and  unhealthy  wounds,  ulcerating  cancerous  growths, 
phagedenic  ulcers,  etc.  It  is  said  that  its  antiseptic  property  is 
superior  to  that  of  carbolic  acid,  and  as  an  odorless  preparation,  it 
will  no  doubt  become  a  desirable  substitute,  as  it  has  no  corro- 
sive action  and  will  not  injure  textile  fabrics.  To  deodorize 
naphthalin,  simple  mixture  with  benzoic  acid  or  tincture  of  ben- 
zoin does  not  suffice ;  but  if  mixed  with  benzoin  and  then  sub- 
limed, it  loses  its  tarry  odor  and  acquires  a  pleasant  smell  which 
it  retains. 

NAPHTHOL-NAPHTHOL. 

Formula.— Ci^H^O=^C,,U^,OH. 

Derivation. — Naphthol  is  an  alcohol  derived  from  Naphthalene 
(CjoHg),  which  is  obtained  from  coal-tar  in  the  form  of  white 
shining  crystals  of  a  strong,  disagreeable  odor,  soluble  in  alcohol, 
but  insoluble  in  water,  and  employed  locally  in  indolent  ulcers 
and  as  a  disinfectant  in  pus-pockets  and  wounds  and  skin  diseases. 
(See  Naphthalene.) 

Medical  Properfies  and  Therapeutic  Uses. — There  are  two  forms 
of  Naphthol,  known  as  a  and  b  Naphthol,  the  latter  being  em- 
ployed medicinally  on  account  of  its  less  irritating  and  injurious 
action.  It  is  in  the  form  of  light-brown  crystals,  soluble  in  hot 
water,  and  possessing  antiseptic  properties,  and  employed  inter- 
nally and  locally  in  the  form  of  ointment  with  vaselin  dissolved 
in  alcohol,  ether  or  olive  oil,  in  the  proportion  of  two  per  cent. 
It  is  employed  in  parasitic  diseases  of  the  skin,  and  as  a  general 
antiseptic. 

Hydronaphthol. — The  chemistry  of  this  agent,  which  is   sup- 


NAPHTHOL.  ^'ji 


posed  to  be  a  form  of  b  naphthol,  is  not  well  known.  It  is  in  the 
form  of  light  fawn-colored  crystalline  flakes,  having  a  feeble  odor 
and  taste.  As  a  germicide,  it  apparently  possesses  the  power  of  pre- 
venting the  development  of  germs  and  their  spores.  It  resembles 
capsicum,  in  possessing  slight  stimulating  and  counter-irritant 
properties,  but  is  not  so  powerful. 

Dental  Uses, — Hydronaphthol  is  employed  for  treating  the 
canals  of  pulpless  teeth,  pericemental  inflammation  of  septic  origin, 
especially  in  the  eaHy  stages  before  pus  has  formed.  Dr.  Jas. 
Truman  recommends  a  solution  of  i  :  looo  of  water  for  injection 
into  pulp-canals;  and  Dr.  E.  C.  Kirk  recommends  a  paste  of 
hydronaphthol  and  glycerine,  pumped  into  a  thoroughly  cleansed 
pulp-canal  in  pericemental  inflammation  from  septic  causes,  to 
remove  the  soreness  and  inflammation  in  a  few  hours ;  it  should 
be  retained  by  a  temporary  filling  of  gutta  percha.  It  is  also 
recommended  as  an  ingredient  for  a  mouth  wash  for  diseased 
gums  and  mucous  membrane. 

Alpha-oxynaphthoic  acid  (or  alpha-naphthol-carbonic  acid)  is  pre- 
pared in  a  similar  manner  to  salicylic  acid,  naphthol  being  substi- 
tuted for  phenol.  Its  formula  is  CmHg,COOH.  It  is  obtained 
by  bringing  together,  under  strong  pressure,  and  at  an  elevated 
temperature,  alpha-naphthol,  sodium  and  carbonic  acid  gas.  It 
is  nearly  insoluble  in  water,  but  soluble  in  the  alkalies  and  alka- 
line carbonates,  forming  salts,  which  are  colorless  and  of  neutral 
reaction,  and  more  soluble  in  hot  and  cold  water  than  the  acid 
itself.  It  is  antiseptic  and  germicide,  experiments  upon  bacteria 
giving  favorable  results. 

DENTAL    FORMULA. 

Antiseptic  and  Stimulant  Mouth  ^Vash, 

For  use  especially  in  Alveolar  Pyorrhcea. 

Dr.  Chas.  B.  Atkinson, 

R.         Hydronaphthol ^ij 

Tinct.  calendulas ^iv 

Aquae  dest.  q.  s.  ad,    .    .    .    •    •    • J  viij,  M. 

SiGNA. — Use  daily. 


472  DENTAL  MEDICINE. 


Fragrant  and  Antiseptic  Mouth  Wash. 
Dr.  a.  W.  Harlan. 

R .        Saffrol 360  min 

Oil  of  pinus  pomilia 120  min 

Oil  of    curacoa 120  min 

Oil  of  vetivert 6  drops 

Oilof  wintergreen 24  drops 

Oil  of  anise,  Saxony •    •    .            .    .  6  drops 

Oil  of  rose  geranium,  A f. 6  drops 

Naphthol 60  grs 

Deodorized  alcohol 24  f.  oz 

Solution  of  saccharine  .    , ^  f.  oz 

Glycerine 8  f.  oz 

Purified  talcum 2  troy  oz.  M 

NITROUS  OXIDE— PROTOXIDE  OF  NITROGEN. 
LAUGHING    GAS. 

Formula. — NjO.     Sp.  gr.  compared  with  air  is  about  1.6. 

Derivation. — The  discovery  of  Nitrous  Oxide  Gas  was  made 
by  Dr.  Priestly  in  1776,  and  scientific  investigation  demonstra- 
ting its  respirability,  by  Sir  Humphrey  Davy,  the  results  of  which 
were  published  some  twenty  years  afterward.  To  Dr.  Horace 
Wells,  a  dentist  of  Hartford,  Connecticut,  is  due  the  credit  of 
having  demonstrated  its  property  as  an  anaesthetic  agent  for  the 
relief  of  pain  during  surgical  operations,  in  the  year  1844. 

Nitrous  oxide  is  obtained  by  heating  the  salt  nitrate  of  am- 
monia in  a  glass  retort  until  it  melts,  and  then  boils,  dissolving 
into  a  vapor  of  water  and  into  a  permanent  gas.  The  salt 
nitrate  of  ammonia  is  obtained  in  three  forms — the  crystallized, 
the  granulated  and  the  fused.  The  fused  form  is  prepared  by 
melting  the  crystallized  nitrate  of  ammonia,  and  allowing  it  to 
solidify  on  cooling  ;  the  granulated  is  prepared  by  evaporating  the 
solution  to  a  density  sufficient  to  solidify  on  cooling,  and  agitating 
the  mass  until  it  becomes  cool. 

As  it  is  very  important  to  use  a  pure  form  of  the  nitrate  of 
ammonia  in  the  generation  of  nitrous  oxide  gas,  the  salt,  either  in 
the  fused  or  granulated  state,  may  be  tested  by  heating  it  on 
platinum,  when  the  nitrate,  if  pure,  should  volatilize  perfectly. 
It  may  also  be  tested  by  a  few  drops  of  chloride  of  barium,  which 


NITROUS  OXIDE. 


473 


should  not  give  a  precipitate  when  added  to  the  nitrate  of  am- 
monia; should  it  do  so,  then  sulphuric  acid  is  present;  or  the 
nitrate  of  ammonia  may  be  tested  by  a  solution  of  nitrate  of  silver, 
which  will  also  give  a  precipitate,  if  chlorine  is  present.  The 
test  with  nitrate  of  silver  may  be  made  by  dissolving  a  drachm  or 
the  nitrate  of  ammonia  in  half  a  glass  of  distilled  water  and  adding  a 
few  crystals  of  the  nitrate  of  silver.  If  the  nitrate  of  ammonia  is 
pure,  the  solution  will  remain  perfectly  clear;  but  should  chlorine 
be  present,  it  will  show  a  clouded  appearance,  and  should  be  dis- 
carded, as  it  is  not  fit  to  generate  the  gas  from. 

The  salt  nitrate  of  ammonia  is  a  white,  crystalline  substance, 
formed  by  neutralizing  dilute  nitric  acid  by  means  of  carbonate 
of  ammonia,  and  is  so  constituted  as  to  be  resolved  into  nitrous 
oxide  and  water.  A  pound  of  the  salt  will  generate  about  thirty 
gallons  of  the  gas.  In  generating  nitrous  oxide  gas,  care  must 
be  taken  to  preserve  its  purity;  consequently  it  becomes  im- 
portant to  maintain,  as  nearly  as  possible,  an  equal  temperature 
during  its  manufacture  ;  and  should  any  nitric  oxide — binoxide  of 
nitrogen — be  formed,  which  may  be  done  by  too  high  a  heat 
under  the  retort,  it  is  necessary  to  remove  it  and  other  impurities, 
by  the  aid  of  solutions  of  caustic  potash  and  copperas;  the  caustic 
potash  neutralizing  any  free  nitric  acid  present,  and  the  copperas 
removing  either  chlorine  or  nitric  oxide.  The  salt  nitrate  of 
ammonia  is  perfectly  fused  at  226°  F.,  emits  white  fumes  at 
302°  F.,  and  begins  to  evolve  gas  at  460°  F.  At  500°  F.  the 
impurity,  nitric  oxide^  is  given  ofF;  hence  the  temperature  during 
the  process  should  not  be  permitted  to  rise  above  482°  F.,  which 
can  be  determined  by  thermometers  prepared  for  the  purpose. 
No  red  fumes  should  pass  from  the_retort. 

Liquefied  Nitrous  Oxide. — Nitrous  oxide  gas,  as  principally  used 
at  the  present  time,  is  in  the  form  of  condensed  gas,  being  lique- 
fied and  solidified  under  great  pressure,  and  secured  in  iron 
cylinders,  from  which  it  escapes  into  an  inhaling  bag  when 
needed  for  use  by  turning  a  stop-cock.  Liquefied  nitrous  oxide 
is  a  colorless  fluid,  having  specific  gravity  of  0.908,  and  at  a  very 
low  temperature  (148°  F.)  it  congeals  into  a  transparent  crys- 
talline solid.     It  is  prepared  by  condensing  the  gas  by  a  pressure 


474  DENTAL  MEDICINE. 


of  fifty  atmospheres  at  a  temperature  of  40°  F.,  and  may  be  kept 
in  the  iron  cylinders  for  an  indefinite  period.  The  advantages 
of  the  condensed  form  of  the  gas  are  its  purity,  convenience 
for  use  whenever  needed,  the  large  supply  which  can  be  kept 
for  use,  and  the  freedom  from  deterioration,  notwithstanding  its 
age. 

Nitrous  oxide  is  an  elastic,  colorless  gas,  with  a  faint,  but 
agreeable  odor  and  a  sweetish  taste,  which  it  imparts  to  water. 
Under  a  pressure  of  fifty  atmospheres  at  about  40°  F.,  it  becomes  a 
clear,  colorless  liquid,  and  at  about  148°  F.  below  zero,  it  freezes 
into  a  beautiful,  clear  crystalline  solid.  By  the  evaporation  of 
this  solid,  a  degree  of  cold  may  be  produced  far  below  that  of 
carbonic  acid  bath  in  vacuo,  or  lower  than  170°  F.  The  wash- 
ing of  nitrous  oxide  gas,  and  the  retention  of  it  over  water  for 
any  length  of  time,  is  attended  with  considerable  loss,  as  much  of 
it  is  absorbed,  especially  if  the  water  is  cold ;  such  loss  may  be 
avoided  to  a  great  extent  by  using  water  of  an  elevated  tempera- 
ture or  a  strong  solution  of  common  salt.  The  impurities  of 
nitrous  oxide  gas  are  air,  water,  nitric  oxide  or  binoxide  of  nitro- 
gen, chlorine  and  hyponitric  acid.  The  mixture  with  air  which 
may  occur  in  the  receiver,  or  when  the  patient  is  inhaling  the 
gas,  merely  dilutes  it  as  does  also  the  vapor  of  water.  Nitric 
oxide,  however,  is  a  dangerous  impurity,  and  with  others  may  be 
generated  even  when  pure  nitrate  of  ammonia  is  used  in  pre- 
paring the  gas  j  this  impurity  is  also  one  of  the  most  difficult  to 
separate  from  the  gas.  Like  nitrous  oxide,  nitric  oxide  is  a 
colorless  gas,  lighter  and  less  soluble  in  water,  and  if  it  is  gener- 
ated is  liable  to  pass  through  the  washing  solutions  into  the  gas- 
ometer or  receiver;  nitric  oxide,  however,  need  not  be  generated 
if  the  proper  care  is  observed  with  regard  to  the  degree  of  heat 
under  the  retort  which  contains  the  nitrate  of  ammonia. 

Chlorine  is  also  a  dangerous  impurity,  and  may  be  set  free  if 
the  salt  nitrate  of  ammonia  contains  muriate  of  ammonia  (sal- 
ammoniac)  and  chloride  of  ammonium.  To  prevent  such  con- 
tamination, the  tests  of  the  salts  before  referred  to  may  be  made. 
Nitrous  oxide  gas  supports  combustion  with  almost  the  same 
promptness   as   pure   oxygen ;   and   although   nearly  identical  in 


NITROUS  OXIDE.  475 


constitution  with  atmospheric  air,  it  differs  from  it  both  in  the 
proportion  of  its  constitutional  elements  and  in  the  manner  of 
their  association.  Nitrous  oxide  contains  about  one-third  of 
oxygen  to  two-thirds  of  nitrogen,  while  atmospheric  air  has  only 
about  one-fifth  of  oxygen  to  four-fifths  of  nitrogen. 

Again,  in  nitrous  oxide  the  elements  nitrogen  and  oxygen  are 
in  chemical  combination  with  each  other,  while  in  atmospheric 
air  there  is  no  apparent  chemical  union  whatever. 

Medical  Properties  and  Physiological  Action. — Concerning  the 
therapeutic  application  of  nitrous  oxide.  Dr.  L.  Turnbull  says  : 
"  Neuralgia,  uncomplicated,  will  sometimes  be  relieved  by  a  ^ew 
inhalations  of  nitrous  oxide  gas.  Nervous  aphonia,  this  peculiar 
form  of  loss  of  power  over  the  voice,  usually  the  result  of  hysteria, 
will  be  much  improved  by  the  patient  inhaling  sufficient  nitrous 
oxide  gas  to  produce  a  partial  loss  of  sensation  and  muscular 
relaxation.  Local  paralysis  has  been  benefited,  where  there  was 
no  brain  lesion,  by  the  gentle  stimulation  by  the  first  stages  of  the 
gas,  or  the  tingling  and  stimulating  effect  on  the  muscles. 
Asthma,  when  of  a  spasmodic  character  is  often  much  improved 
by  causing  the  patient  to  pass  into  the  stage  of  relaxation,  em- 
ploying it  every  other  day  for  a  week  or  two.  It  also  tends  to 
expand  the  lungs."  Dr.  George  J.  Ziegler  found  the  solution  or 
the  gas,  in  water,  of  much  utility  in  diseases  of  the  lungs,  kidneys, 
and  other  affections  of  this  class.  Dr.  M.  Price  claims  to  have 
employed  nitrous  oxide  gas  in  many  cases  of  phthisis  with  ad- 
vantage, and  a  number  of  dentists  have  been  told  by  consumptive 
patients  that  they  have  been  benefited  by  the  inhalation  of  nitrous 
oxide  gas. 

Nitrous  oxide  gas  is  not  only  the  most  pleasant,  but  is,  com- 
bined with  oxygen,  the  safest  general  anaesthetic  in  use,  and  the 
greatest  objection  to  its  administration  is  the  very  short  anaes- 
thetic stage  which  it  induces,  unless  the  inhalation  of  the  gas  be 
continued,  which  is  impossible  in  operations  upon  the  mouth. 
When  inhaled,  the  first  effect  is  dizziness,  with  ringing  noises  in 
the  ears,  a  tingling  sensation,  extending  to  the  extremities,  an 
uplifting  of  the  whole  system,  followed  by  fulness  or  expansion 
of  the  chest,  and  a  loss  of  sensation  throughout  the  entire  body. 


476  DENTAL  MEDICINE. 


According  to  the  temperament,  the  stage  of  excitement  is  tran- 
sient or  prolonged  •,  in  some  cases  there  are  strange  illusions, 
with  a  form  of  intoxication,  which  may  be  manifested  by  decla- 
mation, singing,  laughing  or  crying,  or  melancholy,  with  a  dis- 
position at  times  to  assault  all  near.  Such  effects,  if  the  admin- 
istration is  not  interrupted,  soon  pass  off.  For  surgical  operations, 
the  gas  is  given  with  less  admixture  of  air,  and  the  inhalation 
persisted  in  until  the  stage  of  excitement  is  overcome  and  insen- 
sibility produced,  when  the  face  becomes  exceedingly  pale,  the 
respirations,  at  first  shallow,  become  deep  and  stertorous,  the  jaw 
fixed,  the  eyes  protruding,  and  a  bluish  and  purplish  color  about 
the  lips  and  face,  the  patient  presenting  a  very  alarming  and 
death-like  appearance,  a  condition  of  which  Bartholow  says  :  "  So 
far  as  the  exterior  phenomena  can  afford  any  indication  of  the 
nature  of  the  action,  is  an  asphyxiated  state.  The  blood  ceases 
to  be  oxygenated,  carbonic  acid  accumulates,  and  the  centres  of 
conscious  impressions  are  rendered  inactive  in  consequence  of  the 
deficient  supply  of  oxygen  and  the  excess  of  carbonic  acid.  The 
rational  indications  of  the  nature  of  the  narcosis  produced  by 
nitrous  oxide  are  confirmed  by  physiological  experiment.  It  has 
been  found  that  the  exhalation  of  carbonic  acid  is  decidedly  di- 
minished by  the  inhalation  of  nitrous  oxide,  and  that  animals  live 
no  longer  in  an  atmosphere  of  this  gas  than  in  an  atmosphere  of 
hydrogen."  The  same  author  speaks  of  the  fatal  cases  that  have 
occurred,  as  being  with  propriety  attributable  to  the  lethal  action 
of  this  gas,  and  refers  to  various  cases  under  his  own  observation 
in  which  nervousness,  vague  mental  symptoms  and  headache 
have  been  experienced  after  the  inhalations ;  at  the  same  time  he 
pronounces  nitrous  oxide  to  be  almost  free  from  danger.  Prof. 
H.  C.  Wood  believes  that  nitrous  oxide  acts  as  an  anaesthetic  by 
shutting  off  oxygen.  There  is  no  doubt  but  that  the  prompt  ac- 
tion of  nitrous  oxide  gas,  and  the  rapid  subsidence  of  the  nar- 
cosis, have  much  to  do  with  its  safety,  and  account  for  the  im- 
punity with  which  it  is  used.  According  to  recent  investigations, 
^nitrous  oxide  gas  has  no  direct  effect  upon  the  heart  and  vaso- 
motor system,  but  indirectly  causes  a  rise  of  arterial  pressure  by 
the  slight  asphyxia  it   produces.     Although   the  anaesthesia  may 


NITROUS  OXIDE.  •  477 


be  due  in  a  measure  to  the  non-oxygenation  of  the  blood  during 
the  presence  of  this  gas  in  the  blood,  yet  it  causes  anaesthesia 
aside  from  such  influence  by  a  direct  action  on  the  cerebral 
cortex.  The  after-effects  are  rarely  disagreeable,  and  generally  a 
slight  dizziness  which  soon  passes  off.  Nitrous  oxide  gas  has 
the  advantages  of  safety  ;  also  rapid  anaesthesia,  which  is  gener- 
ally induced  in  from  thirty  seconds  to  a  minute  and  a  half,  insen- 
sibility often  occurring  before  complete  unconsciousness ;  also 
the  pleasant  odor  and  taste,  thereby  preventing  repugnance  and 
nausea;  and  the  complete  recovery  from  its  influence  without 
unpleasant  after-effects.  It  generally  requires  six  gallons  or  less 
to  produce  anaesthesia  with  nitrous  oxide  gas ;  hence  the  rubber 
bag  from  which  it  is  inhaled  should  have  a  capacity  of  about  eight 
gallons.  Nitrous  oxide  gas  is  a  very  useful  anaesthetic  in  all 
minor  operations,  such  as  the  extraction  of  teeth,  opening  an  ab- 
scess, boil  or  felon,  or  even  amputating  fingers,  etc.  The  dis- 
advantages it  possesses  are  its  brevity  of  action,  and  the  difficulty 
of  carrying  it  from  place  to  place  ;  but  its  advantage  is  its  almost 
absolute  safety,  as  few  deaths  have  been  caused  by  it  directly. 

Mode  of  Administration. — The  most  improved  apparatus  con- 
sists of  an  iron  cylinder  containing  100  gallons  or  more  of  the 
condensed  or  liquefied  nitrous  oxide,  to  which  is  attached  a  rub- 
ber gas  bag  and  inhaling  tube  with  a  double  valve  and  mouth- 
piece. The  patient,  for  dental  operations,  is  seated  in  a  suitable 
chair  which  will  admit  of  the  back  being  lowered  to  such  a  de- 
gree as  will  bring  the  patient  to  an  almost  horizontal  posture,  and 
the  head  well  supported.  A  piece  of  India-rubber  or  a  firm  cork 
to  which  a  thin,  strong  cord  is  attached,  to  prevent  its  slipping 
down  the  throat,  is  placed  between  the  teeth,  so  as  to  prevent 
the  closure  of  the  jaws,  for,  unlike  chloroform  and  ether,  the 
muscles  become  rigidly  contracted  under  the  influence  of  this 
gas  ;  such  a  prop  also  prevents  injury  to  the  front  teeth  by  the 
patient  biting  too  hard  on  the  mouth-piece  of  the  inhaling  tube. 
The  patient  is  then  directed  to  breathe  deeply  and  regularly,  the 
nose  being  held,  to  prevent  the  admixture  of  atmospheric  air,  and 
the  same  precautions  observed  as  are  necessary  when  administer- 
ing ether  or  chloroform.     (See  Ether.)     The  anaesthetic  state,  or 


478  DENTAL  MEDICINE. 


"surgical  period,"  as  it  is  termed,  is  generally  manifested  by  snor- 
ing, although  this  symptom  does  not  invariably  occur;  when  it 
does,  however,  it  indicates  a  state  of  profound  anaesthesia,  to 
which  it  is  unnecessary  to  carry  the  patient  when  performing 
many  minor  surgical  operations. 

As  more  or  less  excitement  follows  the  inhalation  of  this  gas, 
when  it  is  largely  mixed  with  atmospheric  air,  such  a  condition 
is  either  prevented  or  abbreviated  by  holding  the  nose  of  the  pa- 
tient during  the  inhalation.  The-  patient  should  not  partake  of 
food  for  at  least  two  hours  before  the  administration  of  the  gas, 
but  at  the  same  time  should  not  be  in  a  weakened  condition 
for  want  of  it ;  and  the  dress,  if  tight,  should  be  previously 
loosened,  and  as  soon  as  the  operation  is  completed  the  head 
should  be  gently  moved  to  one  side,  to  allow  the  blood  to  es- 
cape from  the  mouth.  Fresh  air  should  then  be  admitted  into 
the  room,  and  the  patient  supplied  with  it  by  means  of  a  fan. 
(See  Administration  of  Anaesthetics.) 

Therapeutic  and  Dental  Uses. — According  to  the  investigations 
of  Dr.  Ziegler,  nitrous  oxide  is  an  efficient  restorative  when  ad- 
ministered either  in  its  gaseous  state  by  the  lungs,  or  in  con- 
junction with  liquids  by  the  alimentary  canal.  He  recommends 
the  use  of  this  gas  in  moderate  quantities,  so  as  not  to  generate 
too  much  carbonic  acid.  Regarding  nitrous  oxide  and  oxygen 
as  of  primary  importance  in  asphyxia,  and  the  natural  anti- 
dotes to  narcotizing  agents  and  asphyxiated  conditions,  he  advo- 
cates their  use  whenever  practicable,  either  alone  or  in  combina- 
tion with  heat,  and  claims  that  they  will  often  save  life  in  appar- 
ently hopeless  cases. 

The  rapid  action  of  nitrous  oxide  and  the  transient  nature  of 
its  effects  on  the  system,  render  it  a  very  useful  anaesthetic  agent 
for  all  minor  surgical  operations — such  as  extracting  teeth,  lan- 
cing abscesses,  devitalizing  nerves  of  teeth,  etc.,  etc.  It  has  also 
been  successfully  employed  in  the  performance  of  some  capital 
surgical  operations,  where  the  anaesthesia  has  been  kept  up  from 
fifteen  minutes  to  half  an  hour. 

Nitrous  Oxide  and  Oxygen  or  Air^  Combined. — Oxygen  gas  may 
be  combined  with  nitrous  oxide  gas  with  great  advantage;  also 


NITROUS  OXIDE.  479 


nitrous  oxide  and  atmospheric  air,  although  the  good  effects  of  the 
latter  mixture  are  not  so  well  marked  as  "those  of  former  mix- 
ture, yet  both  mixtures  lessen  the  unpleasant  symptoms  which 
may  ensue  from  pure  nitrous  oxide.  It  is  claimed  for  these  mix- 
tures absence  from  all  blueness  of  the  features,  regular,  softly- 
snoring  breathing,  muscular  relaxation,  and  absence  of  conjunc- 
tival reflex  ;  also  that  the  jerky  muscular  movements,  especially 
common  to  children  under  nitrous  oxide,  are  completely  abro- 
gated ;  in  fact  that  the  presence  of  oxygen,  or  air  with  nitrous 
oxide  renders  the  anaesthesia  much  safer.  Dr.  Hewitt  claims 
that  these  mixtures  are  better  than  pure  nitrous  oxide  for  children, 
anemic  and  debilitated  patients,  for  those  who  have  previously 
exhibited  great  susceptibility,  and  are  consequently  difficult  to 
manage  in  dental  practice  for  the  reason  of  the  short  period  of 
available  anesthesia,  those  who  under  nitrous  oxide  alone  have 
experienced  very  disagreeable  sensations,  patients  advanced  in 
years,  those  with  large  tonsils,  and  those  suffering  from  heart  or 
lung  diseases.  An  apparatus  is  now  manufactured,  based  on  the 
ideas  of  Dr.  Hewitt,  but  with  certain  modifications,  for  combin- 
ing nitrous  oxide  and  oxygen  gases  or  air,  which  are  very  satis- 
factory in  carrying  out  this  "  non-asphyxial  method,"  as  this 
mixing  together  of  the  two  gases,  or  air,  and  their  administration 
is  called.  The  anaesthesia  is  produced  by  the  nitrous  oxide  alone, 
the  office  of  the  oxygen,  or  the  air,  being  that  of  a  modifier  of 
the  effects  of  the  nitrous  oxide,  as  there  is  no  danger  of  asphyxia 
from  such  combinations.  There  are  two  cylinders  in  this  ap- 
paratus, one  for  the  nitrous  oxide  and  the  other  for  the  oxygen, 
and  a  mixing  chamber  in  which  the  combination  occurs,  and 
from  which  the  combined  gases  flow  to  the  inhaler.  If  nitrous 
oxide  alone  is  used  with  this  apparatus,  there  is  always  on  hand 
the  oxygen,  which  the  opening  of  a  valve  will  admit  at  once  to 
overcome  any  tendency  to  asphyxiation  which  may  develop. 

Dr.  Hewitt's  conclusions  on  the  administration  of  definite 
mixtures  of  Nitrous  Oxide  and  Air  and  of  Nitrous  Oxide  and 
Oxygen,  are  as  follows:  "i.  When  pure  nitrous  oxide  was 
administered  to  the  human  subject  in  such  a  manner  that  no  free 
oxygen  gained  admission  during  the  administration,  certain  phe- 


480  DENTAL  MEDICINE. 


nomena  arose  which  might  be  regarded  as  being  either  (i)  phe- 
nomena of  anaesthesia  or  (2)  phenomena  of  asphyxia.  2.  The 
anaesthetic  phenomena  of  nitrous  oxide,  although  apparently  very 
different  from  those  of  ether  or  chloroform,  were  in  their  es- 
sential features  remarkably  similar.  3.  The  most  conspicuous 
of  the  asphyxia]  phenomena  of  pure  nitrous  oxide  were  (i)  em- 
barrassed and  deeply  stertorous  breathing;  (2)  cyanosis;  and  (3) 
anoxemic  convulsion.  All  these  might  be  eliminated  without 
interfering  with  the  anaesthetic  effects  of  the  gas  by  administering 
with  it  certain  proportions  of  oxygen,  either  pure,  or  as  atmos- 
pheric air.  4.  There  were  other  less  obvious  asphyxial  phe- 
nomena, such  as  wide  dilatation  of  the  pupils,  swelling  of  the 
tongue  and  adjacent  structures,  and  rapid  cardiac  action,  which, 
like  the  more  important  symptoms  above  referred  to,  might  be 
prevented  or  modified  by  similar  means.  5.  Under  the  influ- 
ence of  pure  nitrous  oxide  breathing  became  deeper  and  quicker 
than  usual.  At  the  end  of  from  55  to  66  seconds  its  rhythm 
became  altered  either  by  (i)  obstructive  stertor,  (2)  anoxemic 
convulsion  attacking  the  respiratory  muscles,  or  (3)  both  condi- 
tions combined.  Paralytic  cessation  of  breathing  was  very  rare, 
and  when  it  occurred  was  dependent  quite  as  much  upon  cerebral 
anemia  from  defective  circulation  as  upon  the  presence  of  un- 
oxygenated  blood  in  the  vessels  supplying  the  respiratory  centres. 
6.  The  deep  and  obstructive  stertor  of  pure  nitrous  oxide 
narcosis  was  not  met  with  when  employing  mixtures  containing 
moderate  percentages  of  air  or  oxygen.  With  such  mixtures 
only  soft  snoring  breathing  was  produced.  When  the  percentage 
of  air  or  oxygen  was  considerable  (thirty  per  cent,  of  air  or 
thirteen  per  cent,  of  oxygen)  respiration  became  less  and  free 
from  all  obstruction.  7.  The  most  marked  cyanosis  was  met 
with  when  very  small  percentages  of  air  (from  three  to  six  per 
cent.)  or  oxygen  (under  three  per  cent.)  were  administered  with 
nitrous  oxide.  As  the  percentage  of  air  or  oxygen  increased 
cyanosis  lessened,  till  with  30  per  cent,  of  air  it  was  very  slight, 
and  with  11  per  cent,  of  oxygen  it  disappeared  altogether." 

Dr.  Hewitt  goes   on    to  state  that  the  same  favorable  results 
occurred  with   the   mixture  of  air   or   oxygen    in  regard  to  such 


NUX   VOMICA.  481 


symptoms  as  anoxemic  convulsion,  reflex  excitement  movements, 
etc.,  which  were  much  more  pronounced  when  pure  nitrous 
oxide  was  administered ;  also  that  the  duration  of  the  anaesthesia 
was  found  to  be  longest  after  the  administration  of  mixtures  con- 
taining from  3  to  II  per  cent,  of  oxygen,  the  maximum  duration 
having  been  attained  with  7  per  cent,  mixtures ;  and  that  with 
nitrous  oxide  and  air  mixtures  the  resulting  anaesthesia  was  dis- 
tinctly longer  than  with  pure  nitrous  oxide,  but  the  results  were 
very  uncertain  in  these  cases.  The  shortest  anaesthesia  was  re- 
corded with  nitrous  oxide  alone  and  with  nitrous  oxide  mixtures 
containing  30  per  cent,  of  air.  His  best  results  were  obtained 
with  mixtures  of  nitrous  oxide  and  oxygen,  the  next  best  with 
nitrous  oxide  and  air,  and  the  worst  with  nitrous  oxide  free  from 
air  or  oxygen.  He  also  found  that  there  was  no  one  mixture  of 
nitrous  oxide  with  air  or  with  oxygen  which  would  successfully 
anaesthetize  every  patient ;  also  that  mixtures  containing  5,  6,  or  7 
per  cent,  of  oxygen  were  the  best  for  adult  males,  and  mixtures  con- 
taining 7,  8,  or  9  per  cent,  the  best  for  females  and  children ; 
that  the  next  best  results  to  those  last  mentioned  were  to  be  ob- 
tained by  mixtures  of  nitrous  oxide  and  air,  from  14  to  18  per 
cent,  of  the  latter  being  advisable  for  anaesthetizing  men,  and  from 
18  to  22  per  cent,  for  anaesthetizing  women  and  children. 

At  a  recent  meeting  of  the  Paris  Academy  of  Medicine,  a 
method  was  suggested  to  obviate  the  disagreeable  incipient  effects 
of  nitrous  oxide  gas,  which  are  often  manifested  by  bad  dreams 
and  the  perception  of  noises  aroused  in  the  mind  of  the  patient 
when  still  in  a  state  of  partial  consciousness,  by  soothing  strains 
of  sweet  music  by  a  powerful  phonograph,  the  tubes  of  which 
are  applied  to  the  patient's  ears  before  the  gas  is  administered  and 
during  the  operation  of  extracting  teeth. 

NUX  VOMICA. 

Source. — The  seed  of  the  Strychnos  nux  vomica^  which  contains 
two  alkaloids,  strychnine  and  brucine^  the  amount  of  strychnine 
being  one-fourth  to  one-half  per  cent.,  and  of  brucine  from  one- 
eighth  to  one  per  cent. 

Strychnine. — Strychnina  (C21H22N2O2) — is  a  white  or  grayish 
31 


482  DENTAL  MEDICINE. 


white  powder  of  a  very  bitter  taste,  almost  insoluble  in  water, 
and  very  soluble  in  boiling  alcohol. 

Sulphate  of  Strychnine. — Strychnines  Sulphas — is  a  white 
salt  in  the  form  of  colorless  prismatic  crystals,  which  are  very 
bitter  and  odorless,  soluble  in  ten  parts  of  water,  somewhat  so  in 
alcohol,  but  insoluble  in  ether. 

Medical  Properties  and  Therapeutic  Uses. — Nux  vomica  and 
strychnine  are  bitter  stomachic  and  muscular  tonics.  In  small 
doses  strychnine  increases  the  gastro-intestinal  secretions,  hastens 
intestinal  movements,  and  elevates  arterial  tension.  In  larger 
doses  the  pupils  are  dilated  and  the  muscles  spasmodically  con- 
tracted. Poisonous  doses  cause  muscular  tremors,  intermittent 
tetanic  spasms,  and  death  from  rigidity  of  the  respiratory  muscles, 
without  any  impairment  of  the  mind. 

Poisonous  quantities  of  strychnine  accumulate  in  the  system, 
on  account  of  the  agent  being  slowly  excreted,  from  very  small 
doses  frequently  administered.  The  antidotes  are  free  evacuation 
of  the  stomach,  vegetable  astringents  to  precipitate  the  strychnine, 
and  the  inhalation  of  ether  or  chloroform,  and  the  hypodermic 
injection  of  chloral.  Strychnine  is  employed  in  anemia,  atonic 
dvspepsia,  constipation,  vomiting  of  pregnancy,  gastralgia,  gastric 
catarrh,  etc.,  of  drunkards,  chlorosis,  purpura,  hemorrhagic  dia- 
thesis, local  paralysis,  poisoning  by  lead,  spasmodic  asthma,  etc., 
etc.  Nux  vomica  is  an  antidote  to  chloral,  and  is  used  in  in- 
termittent fever  as  an  adjunct  to  quinine.  Brucine  is  much 
weaker  than  strychnine,  but  similar  in  its  action,  and  the  pure 
agent  is  analogous  to  cocaine,  possessing  local  anaesthetic  prop- 
erties. For  hypodermic  injection  it  is  resorted  to  in  paraplegia, 
infantile  paralysis,  facial  paralysis,  etc.,  and  also  in  diseases  of 
the  eye,  and  infraorbital  paralysis.  A  half  grain  of  strychnine 
has  produced  a  fatal  result,  and  one-twelfth  of  a  grain  will  pro- 
duce muscular  twitchings,  and  one-sixteenth  of  a  grain  has  proved 
fatal  in  the  case  of  a  child. 

Dose. — Of  Abstractum  nucis  vomica.,  gr.  ^  •,  of  Extractum  nucis 
vomicee.,  gr.  \  to  gr.  \  ;  of  Extractum  nucis  vomica  fluidum.,  ITlj  to 
v  ;  of  Tinctura  nucis  vomica.,  Ttlv  to  x  ;  of  Strychnina.,  gr.  ^-^  to 
jijj ;  of  Strychnina   Sulphas.,  gr.  -^^  to  ^i^  ;   of  Brucine.,  gr.         to  \. 


OLEATES.  483 

DENTAL    FORMULA. 

For  Neuralgia. 

R.         Ext.  nucis  vom gr.v 

Zinci  valerian        ^ij 

Ext.  gentianae ^j. 

Fiat  pill  No.  XX. 

SiGNA. — One  pill  3  or  4  times  a  day. 

OLEATES. 

Medicinal  oleates  are,  according  to  Dr.  J,  D.  Shoemaker, 
definite  chemical  compounds  or  salts,  having  no  excess  of  either 
their  acid  or  basic  radicals,  and  Dr.  Lawrence  WolfF  finds  that 
the  best  and  readiest  method  of  preparing  oleates  is  by  the  double 
decomposition  of  sodium  oleates  with  solutions  of  neutral  salts. 
The  sodium  oleate  is  made  by  the  saponification  of  oleic  acid 
with  sodium  hydrate.  Dr.  Squibb,  howeve  ,  is  of  the  opinion, 
that  in  the  preparation  of  oleates,  none  are  so  good  as  those  made 
bv  the  direct  union  of  the  acid  with  the  drv  base,  without  heat- 
ing, and  that  the  preparation  should  always  be  either  a  liquid  or 
semi-solid  which  is  easily  and  completely  liquefied  by  the  natural 
temperature  of  the  surface  to  which  it  is  applied  ;  and  he  further 
savs  that  in  the  rare  cases  where  the  excess  of  acid  as  a  solvent 
of  the  oleates  proves  an  irritant  to  the  skin,  dilution  with  a  bland 
oil  becomes  admissible.  The  most  common  oleates  in  use  are 
those  of  mercury,  zinc,  lead,  copper,  aluminum,  bismuth,  iron, 
arsenic,  silver,  aconite,  atropine,  morphine,  veratria  and  strych- 
nine. Oleates  of  the  more  active  alkaloids,  namely,  aconitia, 
atropia,  strychnia  and  veratria,  are  usually  made  of  the  strength 
of  two  per  cent,  of  the  alkaloid;  the  oleate  of  morphia  usually 
contains  five  per  cent,  of  the  alkaloid  ;  the  oleate  of  quinine 
usuallv  contains  twenty  per  cent,  of  the  alkaloid.  Dr.  Squibb 
says  that  all  of  these  are  very  simply  and  easily  made  by  putting 
the  weighed  quantity  of  the  alkaloid  into  a  mortar,  adding  a  small 
quantity  of  the  oleic  acid,  little  by  little,  and  triturating  until  the 
alkaloid  is  completely  dissolved.  The  strong  solution  thus  made 
is  then  poured  into  a  tarred  bottle,  and  the  mortar  and  pestle 
rinsed  twice  into  the  bottle  with  small  quantities  of  oleic  acid. 
The  proper  weight  is  then  made  up  by  the  addition  of  oleic  acid. 


484  DENTAL  MEDICINE. 


According  to  the  preparation  of  oleates  as  recommended  by 
Dr.  Shoemaker  — 

Oleate  of  Mercury  is  prepared  by  precipitating  a  solution  of 
sodium  oleate  with  mercuric  chloride,  and  is  the  best  local  stimulant 
and  alterative  application  of  all  the  mercurials.  It  may  be  diluted 
with  either  the  paraffinates,  or,  better  still,  with  lard  or  lard  oils. 
When  applied  to  the  unbroken  skin  it  causes  marked  stimulation, 
bordering  on  congestion.  It  has  great  penetrating  power,  is 
readily  absorbed  by  the  skin,  and  does  not  become  rancid  nor 
stain  the  linen.  It  is  a  valuable  remedy  in  syphilis,  the  treatment 
of  indurations  after  abscesses,  skin  diseases  of  a  scaly  nature, 
obstinate  ulcers,  parasitic  affections,  etc.,  and  may  be  employed 
advantageously  with  other  oleates.  As  it  is  capable  of  producing 
the  constitutional  effects,  it  must  be  employed  carefully. 

A  mixture  of  oleate  of  mercury  gr.  x  to  xx,  with  the  oint- 
ment of  oleate  of  zinc  3j?  is  very  effective  in  chronic  acne  and 
eczema,  especially  in  the  fissured  variety  of  the  latter  common 
to  the  palmar  and  plantar  surfaces.  For  syphilitic  skin  eruptions 
and  in  superficial  ulcers,  oleate  of  mercury  3j?  vvith  oleate  of 
bismuth  Siiji  or  the  same  quantity  of  the  ointment  of  the  oleatte 
of  lead,  acts  promptly  and  efficiently.  For  one  of  the  best  and 
most  efficacious  oily  applications  for  loss  of  hair,  especially  when 
the  scalp  is  harsh  and  dry,  and  the  hairs  dull  and  without  lustre, 
a  preparation  composed  of  oleate  of  mercury  5j  to  ij,  with  oil  of 
ergot  Sj,  is  highly  recommended. 

Oleate  of  Zinc  is  prepared  by  decomposing  a  sodium  oleate 
with  a  saturated  solution  of  zinc  sulphate,  boiling  out  and  drying 
the  precipitate  and  then  reducing  it  to  an  impalpable  powder. 
One  part  of  oleate  of  zinc  melted  with  three  parts  of  lard  or 
oil  gives  a  most  useful  ointment,  but  the  best  results  are  obtained 
from  the  oleate  of  zinc  alone.  It  is  in  the  form  of  a  fine,  pearl- 
colored  powder,  having  a  soft,  soapy  feel,  much  like  powdered 
French  chalk.     It  is  valuable  in  all  forms  of  sweating. 

Oleate  of  Lead  is  prepared  by  precipitating  a  sodium  oleate  with 
a  solution  of  lead  subacetate.  To  form  the  ointment  of  lead 
oleate,  the  washed  and  dried  precipitate  is  melted  with  equal  parts 
of  lard.     Oleate  of  lead  exerts  a  combined  sedative  and  astringent 


OLEATES.  4g5 

action  when  applied  to  denuded  skin,  and  also  arrests  morbid  dis- 
charges, protects  the  surface  and  allays  irritation.  It  is  useful  in 
eczema,  acne  and  other  skin  diseases.  For  skin  diseases,  oleate 
of  lead  o'ji  with  oleate  of  bismuth  o]t  is  very  effectual,  especially 
in  the  fissured  form  of  palmar  and  plantar  eczema;  and  when  the 
cracking  is  very  deep,  to  cause  stimulation,  oil  of  cade  gtt.  xx  to 
XXX  may  be  added.  In  scabies  oleate  of  lead  S'v  with  sulphur 
5ss  is  an  excellent  application. 

Oleate  of  Aluminum  is  prepared  by  decomposing  sodium  oleate 
with  aluminum  sulphate.  The  washed  precipitate,  mixed  with 
equal  parts  of  lard,  forms  an  ointment  of  a  semi-solid,  dark-brown 
color,  which  is  very  astringent  in  its  action.  It  rapidly  arrests 
all  muco-purulent  discharges,  and  is  an  efficient  dressing  for  foul 
ulcers,  sinuses,  burns  and  scabs. 

Oleate  of  Bismuth  is  prepared  by  first  obtaining  crystallized  bis- 
muth nitrate,  and  dissolving  it  in  glycerine  and  decomposing  with 
this  the  sodium  oleate.  It  is  of  the  consistence  of  ointment,  and 
of  a  pearly-gray  color  and  a  soft,  bland  substance.  It  has  an 
emollient  and  somewhat  astringent  action,  and  is  an  excellent  ap- 
plication for  relieving  cutaneous  irritation.  In  pustular  eruptions, 
especially  svcosis,  it  is  a  useful  application ;  also  in  superficial 
erysipelas,  sunburn  and  chronic  inflammation  of  a  portion  of  the 
face. 

Oleate  of  Copper  is  prepared  in  a  similar  way  to  the  oleate  of 
lead,  by  double  decomposition  with  a  saturated  solution  of  copper 
sulphate.  A  ten  or  twenty  per  cent,  ointment  can  be  made  with 
either  cosmoline,  fat  or  lard.  When  applied  to  the  unbroken 
skin,  it  penetrates  deeply,  and  causes  a  slight  stimulation ;  and 
when  applied  to  broken  skin,  it  coats^  it  with  an  insoluble  albu- 
minate. It  is  very  efficient  for  ringworm,  and  in  the  most  obsti- 
nate cases  usually  affects  a  cure.  It  is  also  used  with  advantage 
on  indolent  ulcerated  surfaces,  and  with  effect  on  hard,  horny 
warts  and  corns. 

Oleate  of  Arsenic  is  obtained  from  arsenious  chloride,  made  by 
the  careful  saturation  of  hydrochloric  acid  with  arsenic.  This 
solution  is  mixed  with  sodium  oleate,  when  the  arsenic  oleate  is 
precipitated.     In  the   proportion  of  gr.  xx  to  an  ounce  of  fatty 


486  DENTAL  MEDICINE. 


base,  it  forms  oleate  of  arsenic  ointment,  which  is  soft  and  yellow, 
having  no  action  on  the  skin.  When  applied  to  wounds,  or  ul- 
cerating surfaces,  it  destroys  the  tissue  to  some  depth.  It  is  used 
in  lupus,  the  ulcerating  variety  of  epithelioma,  and,  after  scraping 
the  surface,  to  destroy  warts,  corns,  old  granulations,  etc.  It 
may  be  combined  with  arnica,  opium,  belladonna  or  hyoscyamus. 
A  number  of  other  oleates  are  in  use,  among  them  Nickel  oleate^ 
which  is  a  greenish,  waxy  mass,  used  in  the  form  of  an  ointment, 
containing  from  five  to  fifteen  grains  to  the  ounce  of  lard,  is 
astringent  and  somewhat  escharotic,  and  useful  for  hard,  horny, 
granulating  surfaces;  Silver  oleate^  a  brownish,  pulverent  sub- 
stance, and,  in  the  form  of  ointment,  valuable  for  application  to 
ulcers,  erysipelas,  etc. ;  Cadmium  oleate^  a  yellowish-white  mass, 
and  in  the  form  of  ointment  (five  to  fifteen  grains  to  the  ounce), 
has  an  astringent  and  escharotic  action,  and  is  useful  in  glandular 
enlargements  and  thickening  of  the  integument. 

OLEUM  AMYGDALA  DULCIS-OIL  OF  SWEET  ALMONDS. 

Derivation. — The  Oil  of  Sweet  Almonds  is  obtained  by  first 
depriving  the  almonds  of  the  brown  powder  adhering  to  their  sur- 
face, and  rubbing  them  together  in  a  piece  of  coarse  linen,  then 
grinding  in  a  mill  or  mortar,  and  then  submitting  them  to  pressure 
in  canvas  sacks  between  slightly  heated  plates  of  iron.  The  oil, 
which  is  at  first  turbid,  is  clarified  by  rest  and  filtration.  It  is 
clear,  colorless,  or  of  a  slight  greenish-yellow  tinge,  nearly  in- 
odorous, with  a  bland,  sweetish  taste.  It  will  remain  liquid  at 
temperatures  below  the  freezing  point  of  water. 

Medical  Properties  and  Action. — The  oil  of  sweet  almonds  is 
demulcent. 

Therapeutic  Uses, — It  is  employed  as  an  emulsion  in  pulmonary 
affections  with  cough,  and  as  a  vehicle  for  other  medicines. 

Dental  Uses. — The  oil  of  sweet  almonds  forms  a  pleasant  and 
soothing  application  for  excoriations  of  the  lips  and  inflamed 
mucous  membranes ;  also  for  soothing  application  to  the  small, 
simple,  but  painful  ulcers  which  sometimes  appear  upon  the 
gums,  mucous  membrane  of  the  cheeks,  and  the  tongue.  Almond 
mixture — Mistura  Amygdalce — is  made  by  dissolving  a  mixture  of 


OIL  OF  CAJUPUT.  4S7 


half  an  ounce  of  blanched  sweet  almonds,  30  grains  of  gum  Arabic 
and  1 20  grains  of  sugar,  in  half  a  pint  of  distilled  water.  It  forms 
a  pleasant  demulcent. 

OLEUM  CAJUPUTI— OIL  OF  CAJUPUT. 

Source. — The  volatile  oil  of  the  leaves  of  melaleuca  cajuputi,  a 
tree  indigenous  in  Batavia  and  Singapore.  It  is  transparent,  of  a 
green  color,  with  an  odor  like  camphor,  and  a  warm,  pungent 
taste. 

Medical  Properties  and  Action. — Cajuput  oil  is  a  diffusible  stim- 
ulant, antispasmodic  and  diaphoretic.  Internally  administered  it 
causes  a  sensation  of  warmth  in  the  stomach,  and  excites  the 
action  of  the  heart  and  arteries,  afterward  producing  copious  dia- 
phoresis. Externally,  either  alone  or  in  combination  with  equal 
parts  of  soap  liniment  or  olive  oil,  it  is  an  efficient  rubefacient 
and  stimulant  embrocation.     Its  use  is  becoming  more  common. 

Therapeutic  Uses. — It  is  employed  internally  as  an  antispas- 
modic stimulant  in  typhus  and  other  low  fevers,  spasmodic  cholera, 
gout  and  rheumatism,  neuralgic  affections,  hysteria,  flatulence  and 
flatulent  colic,  headache,  nausea,  etc.  Externally,  in  neuralgia, 
headache,  gout,  rheumatism,  lumbago,  sprains,  contusions, 
paralysis,  etc.,  etc. 

Dose. — Of  cajuput  oil,  gtt.  j  to  gtt.  v,  in  emulsion,  or  on  sugar. 

Dental  Uses. — Cajuput  oil  is  an  efficacious  remedy  for  the  re- 
lief of  odontalgia,  applied  on  lint  or  cotton  to  the  carious  cavity 
of  the  tooth  ;  also  in  neuralgic  affections,  if  they  are  not  connected 
with  inflammatory  action.  It  is  non-irritating  to  soft  tissues,  and 
is  to  a  certain  extent  germicidal.  It  is  employed  in  the  treatment 
of  pulpless  teeth.  It  is  also  employed  to  moisten  the  inner  walls 
of  root  canals  previous  to  filling  them  with  gutta  percha,  as  it  is 
a  solvent  of  that  substance,  and  causes   it  to  adhere  to  the  walls. 

OLEUM  CARYOPHYLLI— OIL  OF  CLOVES. 

Source. — Oil  of  cloves  is  obtained  from  the  dried  flower  buds 
of  the  caryophyllus  aromaticus,  an  evergreen  tree,  of  the 
natural  order  Myrtacea — myrtle  order — a  native  of  the  Indies. 


488  DENTAL  MEDICINE. 


The  unexpanded  buds  are  of  a  dark-brown  color,  with  a  yellow- 
ish red  tint. 

The  oil  is  prepared  by  distilling  cloves  with  water,  to  which 
common  salt  is  added,  in  order  to  raise  the  temperature  to  the 
boiling  point.      It  has  a  fragrant  odor,  and  a  hot,  acrid  taste. 

Medical  Properties  and  Action. — Oil  of  cloves  contains  tannic 
acid,  a  pungent,  volatile  oil,  resin,  etc.,  and  two  substances — a 
hydro-carbon,  caryophyllin.,  and  an  oxygenated  oil,  eugenol^  called 
an  acid  on  account  of  its  possessing  acid  properties.  Oil  of  cloves 
is  an  aromatic  and  powerful  stimulant.  Although  it  is  a  very 
fluid,  clear  and  colorless  preparation  when  fresh,  it  becomes 
yellow  by  exposure,  and  ultimately  reddish-brown,  with  the  odor 
of  cloves,  and  a  hot,  aromatic  taste.  Like  cloves,  the  oil  acts 
less  upon  the  system  at  large  than  on  the  part  to  which  it  is 
immediately  applied. 

.  Therapeutic  Uses. — Oil  of  cloves  is  sometimes  administered  to 
relieve  nausea  and  vomiting,  to  correct  flatulence  and  excite 
digestion  when  languid  :  but  its  chief  use  is  to  modify  the  action 
of  other  medicines. 

Dose. — Of  oil  of  cloves,  gtt.  ij  to  gtt.  vj. 

Dental  Uses. — In  dental  practice,  oil  of  cloves  is  employed  to 
relieve  odontalgia,  in  the  form  of  a  drop  or  two  upon  cotton, 
introduced  into  the  carious  cavity  of  a  tooth  ;  it  obtunds  the  pain 
by  an  over-stimulating  effect  upon  the  irritable  pulp.  It  is  also 
employed  for  the  same  purpose  in  combination  with  other  agents, 
such  as  morphia,  sweet  spirits  of  nitre,  etc.  When  the  use  of 
creasote  or  carbolic  acid  is  prohibited,  owing  to  the  patient's 
idiosyncrasy,  the  oil  of  cloves  may  be  substituted. 

The  oil  of  cloves  has  also  the  effect  of  rendering  creasote  and 
carbolic  acid  more  pleasant,  without  interfering  with  their  action, 
being  added  in  equal  admixture.  It  is  also  employed  very  satis- 
factorily in  the  treatment  of  alveolar  abscess,  putrid  pulps,  being 
applied  like  creasote  or  carbolic  acid,  or  combined  with  other 
agents. 

Eugenol.,  CioH,202,  also  called  eugenic  acid,  is  an  active  prin- 
ciple of  oil  of  cloves,  and  is  prepared  by  decomposing  eugenate 
of  potassium  with  sulphuric  acid.     It  is  in  the  form  of  a  colorless 


COD-LIVER  OIL.  ^<,c, 


oil,  of  the  specific  gravity  of  1.076.  Its  odor  resembles  that  of 
oil  of  cloves,  and  has  a  sharp,  penetrating  taste.  It  does  not 
decompose  at  ordinary  temperatures,  and  is  not  affected  by 
exposure  to  the  air.  It  is  soluble  in  water  and  alcohol,  but  the 
aqueous  solution  is  the  more  potent  as  a  germicide.  It  is  not 
poisonous,  and  when  pure  will  coagulate  albumen.  For  dental 
uses  eugenol  is  of  considerable  value.  When  applied  to  exposed 
or  partially  exposed  pulps  of  teeth  it  usually  relieves  the  pain  in 
from  one  to  two  minutes.  For  inflamed  and  congested  pulps,  it 
has  been  suggested  to  first  apply  a  solution  of  borax  and  then 
eugenol.  It  also  answers  well  as  a  dressing  for  root  canals,  espe- 
cially after  the  removal  of  a  recently  devitalized  pulp.  In 
alveolar  pyorrhoea,  it  is  used  in  solution,  i  part  of  eugenol  to 
1000  of  water,  for  the  purpose  of  cleansing  the  pus  pockets.  In 
alveolar  abscesses  it  has  been  suggested  as  an  injection,  after  the 
use  of  peroxide  of  hydrogen,  taking  the  precaution,  in  cases  of 
abscesses  with  a  fistulous  tract,  to  seal  the  root  at  the  apex.  It 
has  also  been  successfully  employed  in  the  treatment  of  benign 
tumors  of  the  mouth,  in  the  form  of  an  injection  of  two  drops. 

OLEUM  MORRHU.^i— COD-LIVER  OIL. 

Source. — Cod-liver  oil  is  obtained  from  the  liver  of  the  cod, 
Gadus  morrhucc^  and  is  in  the  form  of  a  fixed  oil,  containing 
biliary  principle,  traces  of  iodine,  bromine,  phosphorus,  lime, 
magnesia,  iron,  soda  and  sulphuric  and  phosphoric  acids;  also  a 
principle  known  as  gaduin.  By  distillation  with  ammonia,  it 
yields  prop\lamin.  The  pale  oil  is  considered  to  be  the  best  for 
internal  use,  and  is  the  officinal  preparation.  Iodine,  phosphorus, 
bromine  and  iron  are  often  combined  with  cod-liver  oil,  but  are 
considered  to  add  nothing  to  its  therapeutical  powers.  The 
special  medicinal  value  of  this  oil  depends  upon  the  gaduin  and 
propylamin,  which  are  constituents  of  bile,  iodine,  phosphorus, 
bromine,  etc.,  as  well  as  upon  the  common  ingredients  of  animal 
fat.  The  phosphates,  hypo-phosphites,  or  the  lacto-phosphate  of 
lime  are  often  combined  with  cod-liver  oil,  with  excellent  effects. 

Medical  Properties  and  Therapeutic  Uses. — Cod-liver  oil  is  con- 
sidered to  be  a  valuable  remedy  in  certain  forms  of  phthisis,  such 


490  DENTAL  MEDICINE. 


as  the  chronic  forms — chronic  tuberculosis  and  fibroid  lung ;  but 
not  in  acute  phthisis  and  caseous  pneumonia;  also  in  chronic 
affections  of  the  brain  and  nervous  system,  and  such  skin  diseases 
as  lupus,  ecthyma,  psoriasis,  etc.  It  is  also  employed  in  sequelae 
of  scarlet  fever,  chronic  bronchitis,  emphysema,  chronic  rheuma- 
tism and  rheumatic  arthritis,  strumous  synovitis,  scrofula,  caries 
and  necrosis  of  bone ;  scrofulous,  rickety  infants  and  chlorotic 
girls  derive  benefit  from  warm  baths  and  inunctions  of  the  oil ; 
also  lean  persons.  Inunction  with  cod-liver  oil  is  also  useful  in 
rubeola,  scarlatina,  erysipelas,  high  fevers,  catarrhal  attacks,  scrof- 
ula, phthisis,  chronic  dysentery,  etc.  It  builds  up  the  tissues, 
repairs  waste  and  supplies  nervous,  muscular  and  digestive  power. 
It  may  be  administered  in  ale,  beer,  coffee,  lemon  juice,  hot 
whiskey  punch,  compound  spirits  of  lavender  and  brandy,  or 
washing  out  the  mouth  with  whiskey  or  brandy,  or  as  an  emulsion 
made  with  glycerine  and  yolks  of  eggs,  and  flavored.  It  is  also 
used  in  the  preparation  of  bread  in  form  of  rolls ;  ether  added  to 
it  promotes  its  digestion ;  fifteen  minims  of  ether  to  every  half- 
ounce  of  the  oil. 

Dose. — Of  cod-liver  oil,  f5j  to  5iv. 

OPIUM. 

Source. — Opium  is  obtained  from  the  unripe  capsules  of  the 
papaver  somniferum,  of  the  natural  order  Papaveracea — poppy 
order,  in  the  form  of  a  concrete  juice,  which  exudes  from  in- 
cisions, and  which  is  permitted  to  evaporate  spontaneously. 
Commercial  opium  is  in  the  form  of  irregular  masses,  of  from  a 
few  ounces  to  several  pounds  in  weight,  with  a  moist,  brown  or 
chestnut  surface,  and  a  peculiar  odor  and  nauseous  taste.  The 
purest  form  should  have  a  chestnut  color,  a  strong  aromatic  flavor, 
and  a  dense  consistence,  and  break  with  a  deeply  notched  fracture, 
and  when  drawn  across  white  paper  leave  an  uninterrupted  line. 
The  alkaloid  morphine  is  the  most  important  of  the  chemical 
constituents  of  opium.     (See  Morphine.) 

Medical  Properties  and  Uses. — As  an  anodyne  and  hvpnotic 
opium  possesses  the  power  of  relieving  pain  and  inducing  sleep  ; 
it  relaxes  muscular  spasm,  and  hence  is  a  very  efficient  remedy  in 


OPIUM. 


491 


tetanus,  spasms,  nervous  irritability  and  discharges  of  a  morbid 
nature.  It  excites  the  circulation  as  a  first  action,  and  increases 
the  temperature  of  the  skin,  and  causes  an  agreeable  exhilaration 
of  the  intellectual  faculties,  so  much  so  as  to  be  used  by  some  as 
an  habitual  narcotic,  which  is  finally  destructive  to  both  the  phys- 
ical and  mental  functions.  But  the  stage  of  excitement  is  very 
transient,  and  is  succeeded  by  a  falling  of  the  pulse,  a  diminished 
susceptibility  to  external  impressions,  confusion  of  mind  and  the 
loss  of  consciousness  in  deep  sleep.  Other  effects  are  also  mani- 
fested, such  as  dryness  of  the  throat,  thirst,  and  in  some  cases, 
nausea  and  vomiting,  with  an  itching  miliary  eruption  on  the 
skin. 

Taken  in  large  or  poisonous  doses,  opium  does  not  cause  any 
excitement,  but  giddiness  and  stupor  rapidly  supervene,  with  a 
lessening  in  the  frequency  of  the  pulse,  but  not  in  fulness,  a  tend- 
ency to  sleep,  which  is  irresistible,  and  finally  coma,  in  which 
the  breathing  is  heavy  and  stertorous,  the  pulse  slow,  and  the 
pupils  contracted,  with  a  sinking  of  the  pulse  and  relaxation  of 
the  muscles  immediately  preceding  death  ;  in  the  case  of  children 
death  is  often  preceded  by  violent  convulsions. 

The  antidotes  in  poisoning  by  opium  are  the  stomach  pump, 
emetics  in  double  doses,  such  as  sulphate  of  zinc,  in  doses  of  gr. 
XX  to  gr.  XXX,  or  sulphate  of  copper,  gr.  v  to  gr.  x ;  also  mustard 
in  powder,  .5ss,  or  powdered  alum,  answer  as  emetics,  strong 
coffee,  keeping  the  patient  in  motion,  counter-irritation  to  nape 
of  neck,  flagellation  to  the  palms  of  the  hands  and  soles  of  the 
feet,  and  the  electro-magnetic  battery,  which  is  often  efficient 
when  other  measures  fail,  artificial  respiration,  and  belladonna,  in 
hypodermic  injections  of  its  alkaloid  atropine,  in  solution.  No 
local  lesions  are  found  after  death. 

Therapeutic  Uses. — Opium  as  an  anodyne  and  hypnotic  is  em- 
ployed in  almost  all  diseases  where  the  necessity  of  assuaging 
pain  and  inducing  sleep  is  required.  (See  Morphine.)  Opium  is 
contra-indicated  where  there  is  a  tendency  to  apoplexy  or  coma, 
or  where  an  unusual  susceptibility  to  its  influence  exists,  and  it 
should  be  administered  to  the  very  young  and  very  old  with  great 
caution.      When  long  administered  it  is  necessary  to  increase  the 


492  DENTAL  MEDICINE. 


dose.  Externally,  in  the  form  of  powder,  it  is  applied  to  irrita- 
ble ulcers,  etc.,  and  to  the  rectum,  as  suppositories. 

Dose. — Of  opium,  in  powder  or  pill,  as  an  anodyne  and  hyp- 
notic, gr.  j. 

Dental  Uses. — Opium  is  employed  as  an  anodyne  in  convul- 
sions of  teething,  but  must  be  administered  with  great  care  and 
in  small  doses ;  also  as  an  anodyne  preparatory  to  lancing  the 
gums  of  children  ;  also  in  mercurial  salivation,' to  arrest  the  ex- 
cessive secretion,  in  doses  of  gr.  j  every  four  hours ;  also  in  neu- 
ralgia; but  it  is  inferior  to  aconite.  A  small  lump  of  opium  in 
contact  with  an  aching  tooth  pulp  will  relieve  the  pain,  or  the 
powder  may  be  used  for  the  same  purpose.  In  the  form  of 
wine  and  tincture,  opium  is  serviceable  in  odontalgia,  periodon- 
titis, inflamed  gums  and  mucous  membrane  of  the  mouth  ;  in 
injections,  for  alveolar  abscess,  when  it  is  often  used  in  com- 
bination with  tincture  of  iodine.  The  wine  of  opium  is  a 
more  soothing  and  pleasant  application  than  the  tincture  of 
opium. 

ViNUM  Opii — JVine  of  Opium — is  obtained  by  macerating  two 
ounces  of  powdered  opium,  together  with  cinnamon  and  cloves, 
in  one  pint  of  white  wine.     Dose^  TUv  to  5j. 

Dental  Uses. — Employed  as  a  soothing  and  anodyne  applica- 
tion to  inflamed  and  tender  gums  and  mucous  membrane,  odon- 
talgia, ulcerations  of  mouth,  alveolar  abscess,  periodontitis, 
pulpitis,  etc.  Dr.  W.  H.  Atkinson  recommended  wine  of  opium 
by  means  of  injection,  into  pockets  and  cavities,  where  such  ex- 
ist, in  cases  of  aching  gums  or  teeth. 

Dover's  Powdek-^PuIvis  ipecacuanha  et  opii.  Dose^  gr.  x. 
Ten  grains  contain  one  grain  each  of  ipecac  and  of  opium,  and 
eight  grains  of  sugar  of  milk.  For  influenza  or  "  common  cold," 
a  dose  of  Dover's  powder  taken  at  bedtime,  with  such  adjuncts 
as  warm  clothing,  hot  drinks,  foot-baths,  etc.,  to  promote  profuse 
diaphoresis,  proves  very  effective.  Ten  grains  at  bedtime  is 
also  a  very  serviceable  remedy  for  inflammations  of  the  peridental 
membrane. 

TiNCTURA  Opii —  Tincture  of  Opium — laudanum  is  composed 
of  powdered  opium,  5iiss;  diluted  alcohol,  Oj.     Dose,  Itlv  to 


OPIUM. 


493 


lUxxx  J  25  drops  are  equivalent  to  one  grain  of  opium.  Its 
strength  increases  with  age.  Tincture  of  opium  in  hot  water 
(foij,  to  aquae  ferv.  fSx),  held  for  some  minutes  in  the  mouth,  is 
useful  in  peridental  inflammation. 

One  drachm  of  the  tincture  contains  120  drops.  The  dental 
uses  are  the  same  as  for  wine  of  opium,  but  the  latter  is  the  most 
pleasant  application  for  the  mouth. 

TiNCTURA  Opii  Camphorata — Camphorated  Tincture  of 
Opium — paregoric  elixir — is  prepared  by  macerating  sixty  grains 
of  opium  in  two  pints  of  diluted  alcohol,  with  sixty  grains  of 
benzoic  acid,  a  fluidrachm  of  oil  of  anise,  two  ounces  of  clarified 
honey,  and  forty  grains  of  camphor.  Dose^  foj  to  f^j  or  a  table- 
spoonful,  containing  a  little  less  than  one  grain  of  opium.  Dose 
for  an  infant,  gtt.  v  to  xx.  This  is  an  agreeable  preparation  for 
children. 

TiNCTURA  Opii  Deodorata — Deodorized  Tincture  of  Opium 
— is  composed  of  the  watery  extract  of  opium,  washed  with 
ether,  which  is  afterward  separated,  and  the  residue  dissolved  in 
water  and  mixed  with  enough  alcohol  to  preserve  it.  This  prepa- 
ration of  opium  is  free  from  the  narcotina  and  many  other  in- 
jurious ingredients  of  opium,  and  is  a  valuable  preparation.  Dose.^ 
1TLv  to  KTlxxx. 


DENTAL    FORMULAE. 


A   Stimulating   Injection  for  Abscess 
of  Antrum. 
J.  S.  Smith. 
R.     Glycerinae        ....  f^j 
Tinct.  opii   camph.  .  f ^  ij 
Eau  de  cologne    .    .     ^iv     M, 
SiGNA. — Inject  daily.  ' 

For  Infantile  Diarrhoea  During  Den- 
tition. 

When  there  is  a  tendency  to  an  acid 
fermentation  of  the  food. 

Dr.  Jas.  W.  White. 

First  give  a  grain  of  bicarbonate  of 
sodium,  or  of  potassium  with  anise, 
cinnamon,  or  caraway,  with  each  meal. 


If  undigested  food  or  vitiated  secre- 
tions in  alimentary  tract  are  suspected, 
a  dose  of  castor  oil  and  aromatic  syrup 
of  rhubarb  in  equal  portions — dose,  a 
teaspoonful;  if  torpidity  of  liver,  a  few 
doses  at  intervals  of  two  hours,  of  the 
Twelfth  or  sixteenth  of  a  grain  of 
calomel  with  one  or  two  grains  of 
sodium  bicarbonate.  If  the  diarrhoea 
persists,  use  the  following,  first  pro- 
hibiting the  use  of  farinaceous  or  milk 
food : 

U.     Tinct.  opii gtt.viij 

Bismuth,  subnitrat.    .   5J 
Mucilag.   acaciae    .    .  f,f  ss 
Aquae  menth.  pip.  .    .  f  J  iss.     M. 


494  DENTAL  MEDICINE. 


SiGNA. — A  teaspoonful  every  3  hours  cholera    infantum,    and    no    fever    is 

to  a  child  6  months  old.     Opium  is  present. 

indicated    only    after   all   offending  Dr.  Jas.  W.  White. 

matters  have  been  expelled  from  the  R.     Tinct.  opii  camph.  .    .  f^j 

alimentary  canal.  Ext.  haematoxyll    .    .  gr.xvj 

For  Infantile  Diarrhoea  During  Den-  Mist,  cretse, 

tition.  Aquae  cinnamoni   .  aa  f ^ j.        M. 

If  it  is  due  to  relaxation  from  long  SiGNA. — A  teaspoonful  in  water  every 

continued  wrarm  weather,  or  following  4  hours  for  a  child  6  months  old. 

ORTHOFORM— METHYL-PARA-AMIDO-META-OXY-BENZOATE. 

Formula.— C.HIOH)  (NH2)COOCH3. 

Orthoform  occurs  in  the  form  of  a  white,  voluminous  powder, 
odorless,  and  tasteless,  and  slightly  soluble  in  water. 

Therapeutic  Action. — Orthoform  is  antiseptic,  hemostatic,  and 
a  local  anaesthetic.  It  is  used  as  a  local  anaesthetic  and  antiseptic 
to  relieve  the  pain  of  ulcers,  burns,  wounds,  excoriations,  etc. 
As  it  is  non-toxic  it  may  be  applied  to  large  surfaces  ad  libitum. 
In  the  form  of  ointment  it  is  employed  to  the  extent  of  10  to  20^ 
per  cent,  made  up  with  lanolin.  It  is  also  administered  internally 
in  affections  of  the  gastric  mucous  membrane.  Combined  with 
hydrochloric  acid — "  orthoform  hydrochloride  " — in  the  form  of 
a  soluble  crystalline  salt,  it  anaesthetizes  as  well  as  the  powdered 
orthoform,  but  is  not  applicable  for  subcutaneous  injection. 

Dose. — Of  Orthoform,  gr.  viii  to  xv. 

Dental  Uses. — Orthoform  is  applied  to  ulcers,  excoriations, 
etc.,  as  an  antiseptic,  and  anaesthetic.  It  is  also  recommended 
for  hemorrhage  following  the  extraction  of  teeth ;  after  remov- 
ing the  blood,  the  alveolar  cavity  is  packed  with  the  powdered 
orthoform  to  arrest  the  hemorrhage. 

A  new  form  of  Orthoform  (under  the  name  of  Orthonew) 
has  recently  been  introduced,  this  new  preparation  being 
whiter  and  cheaper  than  the  original  orthoform.  This  new  prep- 
aration is  perfectly  non-irritating,  even  when  applied  in  its  full 
strength,  and  is  used  in  the  same  way  as  the  original. 

OXYQUINASEPTOL— DIAPHTHERIN. 

Formula.  —  HO— QHeNH— O— SO^— CgH,— O— NHQHg 
—OH. 


PAPAIN,  495 

Derivation. — Oxyquinaseptol  is  a  union  of  two  molecules  of 
oxyquinolin  and  one  molecule  of  asceptol,  /'.  ^.,  phenolsulfonic  acid- 

Medical  Properties  and  Uses. — Oxyquinaseptol  is  an  energetic 
antiseptic,  having  little  or  no  caustic  action.  Three  per  cent, 
solutions  possess  anti-bacterial  properties,  and  one  per  cent  so- 
lutions are  sufficient  for  the  treatment  of  wounds,  as  it  is  the 
least  poisonous  of  antiseptics.  It  is  preferred  by  Kronacherand 
Brandt  to  carbolic  acid  or  sublimate  on  account  of  its  ex- 
treme antiseptic  properties  in  small  concentrations,  and  because 
of  its  insignificant  toxic  effects.  It  is  prescribed  in  powder  or 
pill  form,  and  in  thirty  to  fifty  per  cent,  solutions. 

Oxyquinaseptol,  in  the  non-precipitated  form,  is  of  a  yellowish 
sulphur  color,  with  a  slight  phenol  odor,  while  the  precipitate  is 
white. 

Dental  Uses. — As  an  antiseptic  in  all  affections  requiring  anti- 
sepsis, such  as  putrescent  pulps,  abscess,  fistulous  openings,  sup- 
puration from  necrosis  of  maxillary  bones.  Dr.  Brandt,  of 
Berlin,  asserts  that  at  the  present  time  no  antiseptic  material  ex- 
ists which  is  more  valuable  for  like  cases  than  diaphtherin. 

PAPAIN  OR  PAPAIVA— PAPAYATIN. 

Source. — Papain  is  a  ferment  obtained  from  the  Carica  papaya^ 
from  which  exudes,  on  incision,  a  white,  slightly  astringent  and 
milky  juice,  which  contains  the  papain.  It  has  the  taste  of  pep- 
sin and  is  soluble  in  water  and  glycerol. 

Medical  Properties  and  Action. — Papain  is  a  digestive  ferment 
like  pepsin,  its  active  digestive  power  causing  the  solution  of  al- 
buminous substances.  Catillon  denies  that  it  is  a  true  ferment, 
with  power  to  convert  albuminoids  into  peptones ;  hence  it  can- 
not be  substituted  for  pepsin  in  affections  of  the  stomach ;  it  is 
active  in  an  acid,  neutral  or  faintly  alkaline  solution. 

Therapeutic  Uses. — It  is  an  active  solvent  of  false  membranes, 
intestinal  worms,  ascarides  and  taenias,  hence  it  is  employed  in 
diphtheria,  ascarides,  vermiculares,  tapeworm.  Locally,  like 
pepsin,  it  is  employed  in  the  form  of  injections  made  with  a  hy- 
podermic syringe,  in  the  treatment  of  fatty  tumors  and  other 
benign  growths,  and  to  retard  the  growth  of  cancerous  and  other 


496  DENTAL  MEDICINE. 


malignant  tumors,  the  solution  being  injected  well  into  the  sub- 
stance of  the  tumor. 

Dental  Uses. — Papain  is  employed  in  the  treatment  of  ulcers 
and  tumors  of  the  mouth,  both  benign  and  malignant,  the  solution 
being  injected  into  the  substance  of  the  growth  by  means  of  a 
hypodermic  syringe  ;  it  has  also  been  used  to  digest  portions  of  a 
pulp,  requiring  from  24  to  72  hours,  the  cavity  well  secured. 
Dr.  Harlan  states  that  if  one  gram  of  papain  is  made  into  a  thick 
paste  with  glycerol  and  a  drop  of  hydrochloric  acid  solution 
(1-300),  is  added,  it  always  acts  well  in  pulp-digestion,  prior  to 
the  removal  from  the  roots  of  teeth  of  dead  pulp-tissue. 

PARALDEHYDE— PARALDEHYDE. 

Formula.— C^n,^0^=2,C2^iO. 

Derivation. — Paraldehyde  is  a  polymeric  modification  of  alde- 
hyde (CaH^O).  It  is  a  colorless  liquid  of  an  ethereal  odor,  pun- 
gent taste  and  insoluble  in  eight  parts  of  water,  which  is  a  proper 
menstruum.  It  is  frequently  combined  with  chloroform,  oil  of 
almonds  and  syrup  of  orange  peel,  or  cinnamon. 

Medical  Properties  and  Therapeutic  Uses. — Paraldehyde  is  an 
efficient  hypnotic,  similar  in  its  effects  to  chloral,  although  the 
sleep  caused  by  it  is  not  so  deep  nor  so  prolonged.  As  it  does 
not  weaken  or  paralyze  the  heart  or  lungs,  it  is  considered  to  be 
safer  than  chloral.  It  is  employed  as  an  hypnotic  in  fevers, 
rheumatism,  gout,  prurigo,  insomnia,  hysterics,  delirium  tremens, 
some  cases  of  neuralgia,  and  all  mental  and  nervous  disorders.  It 
is  also  used  as  an  expectorant.  Poisonous  doses  cause  respiratory 
paralysis.  The  action  of  paraldehyde  upon  digestion  is  as 
follows  : 

a.  Large  quantities  considerably  accelerated  the  digestion  of 
fibrin,  and  that  the  rate  of  this  acceleration  was  distinctly  in  ratio 
with  the  quantity  used. 

b.  Small  quantities  also  increased,  but  to  a  less  degree,  the 
digestion  of  fibrin. 

c.  Putrefaction  was  prevented  by  the  larger  quantities  of 
paraldehyde,  and  was  delayed  by  the  smaller  quantities. 

Dose. — Of  Paraldehyde,  TTLxv  to  foj,  repeated  if  necessary. 


PENTAL.  49  J 

PENTAL— TRI-METH  Y  L-ETH  YLENE. 

Formu/a.—{CH^)2C.CH,CH^,  or  QHio- 

Derivation. — Pental  is  a  tertiary  amylene,  obtained  by  heating 
amylene  hydrate  in  presence  of  acids.  It  is  a  colorless  liquid  of 
specific  gravity  0.6783  at  32°  F.,  insoluble  in  water,  but  soluble 
in  all  proportions  with  alcohol,  chloroform  and  ether.  It  is  as 
inflammable  as  ether,  and  should  therefore  not  be  exposed  to  a 
flame.  It  boils  at  100.4°  F.,  or  the  latest  preparation  at  38°  C, 
and  burns  with  a  luminous  flame,  and  has  a  penetrating  odor  like 
that  of  mustard-oil. 

Medical  Properties  and  Action. — Pental  is  a  general  anaesthetic 
and  has  been  recommended  by  Dr.  Hollander,  of  Halle,  for 
minor  surgical  operations  on  account  of  no  untoward  effect  being 
produced  by  it  upon  the  tissues  of  the  mouth  and  respiratory- 
passages  ;  that  unpleasant  after-effects  are  exceptional ;  that  con- 
sisting only  of  carbon  and  hydrogen,  to  the  exclusion  of  the 
halogens,  it  therefore  produces  no  evil  after-effects.  It  is  also 
claimed  for  pental  that  the  anaesthesia  comes  on  gradually  with- 
out any  previous  conspicuous  symptoms  whatever ;  that  the 
quickened  pulse  at  the  beginning  soon  returns  to  its  norrnal  state, 
and  notwithstanding  that  the  sensibility  vanishes,  consciousness 
in  most  cases  partially  remains.  Under  the  profoundest  narcosis 
from  pental,  it  is  asserted,  that  patients  when  requested  will  open 
the  jaws,  even  though  they  were  firmly  closed  before,  and 
although  they  look  at  the  operator  with  wide-open  eyes,  still  they 
are  unaware  of  what  is  being  done  with  them.  During  the 
anaesthesia  from  pental  and  after,  no  disagreeable  feeling,  such  as 
nausea,  headache,  etc.,  occurred  in  the  experience  of  Dr. 
Hollander;  and  he  claims  that  he  never  noticed  any  contraction 
of  the  muscles  of  the  jaws  and  fingers,  as  is  the  case  under 
bromide  of  ethyl,  nor  any  depression  of  the  chest  or  syncope, 
which  sometimes  result  from  chloroform  and  bromide  of  ethyl. 
He  also  asserts  that  he  has  administered  pental  to  children  from 
four  to  ten  years  of  age,  and  to  old  people  from  fifty  to  sixty 
with  the  same  results,  and  the  least  stage  of  excitement  is  very 
uncommon,  the  patient  being  always  animated  in  a  friendly, 
cheerful  way,  so  that  it  could  be  termed  laughing-ether.  It  is 
32 


498  DENTAL  MEDICINE. 


also  claimed  that  pental  anaesthesia  differs  from  chloroform  in  that 
it  takes  place  more  rapidly,  and  that  there  is  no  effect  upon  the 
action  of  the  heart  or  respiration,  and  the  administration  in  large 
quantities  appears  to  be  absolutely  free  from  danger.  Narcosis  is 
produced  by  pental  in  from  40  to  45  seconds,  and  the  rules  and 
precautions  in  administering  it  are  the  same  as  for  all  other 
anaesthetics.  Nervous  and  infirm  patients  require  more  of  pental 
than  the  robust ;  and  it  is  not  always  possible  to  determine  when 
the  anaesthesia  is  complete,  as  the  corneal  reflex  remains  some- 
what long  ;  and  even  though  the  raised  hand  should  not  fall  back 
powerless,  the  anaesthesia  may  have  occurred.  Drs.  H.  C. 
Wood  and  D.  Cerna,  however,  from  experiments  made  with 
pental,  arrived  at  the  conclusion  that  pental  will  probably  prove 
to  be  a  dangerous  anaesthetic,  and  if  extensively  used  will  produce 
death  by  cardiac  arrest ;  and  they  also  say  that  it  is  probable  that 
the  after-effects  in  the  human  being  would  be  disagreeable,  as 
they  noticed  in  a  dog  a  peculiar  wild  excitement  directly  after  the 
anaesthesia  had  passed  off.  Pental  is  best  administered  by  means 
of  Junker's  inhaler,  which  also  weakens  its  unpleasant  odor;  the 
use  of  other  apparatus  occasi'ons  too  much  loss,  as  it  is  very  vola- 
tile, and  consumes  more  time.  When  taken  up  by  the  blood, 
pental  is  separated  into  two  substances — water  and  carbonic  acid. 
All  apparel  which  impedes  free  breathing  should  be  removed 
during  the  administration  of  pental,  and  the  room  be  somewhat 
darkened. 

Dental  Uses. — Pental  is  employed  as  a  general  anaesthetic  in 
dental  practice,  principally  for  the  extraction  of  teeth,  and  Dr. 
Hollander  claims  that  in  the  case  of  a  single  extraction  it  is  not 
necessary  to  wait  for  the  disappearance  of  the  corneal  reflex,  as  it 
sometimes  occurs  rapidly,  and  at  other  times  very  slowly ;  and 
that  the  narcosis,  although  somewhat  slower  than  bromide  of 
ethyl,  lasts  longer,  the  duration  being  from  three  to  seven  minutes, 
and  the  time  for  its  production  one-half  to  two  minutes.  Dr. 
Hollander  also  claims  that  pental  has  produced  anesthesia  when 
several  other  prominent  agents  have  failed  ;  but  from  the  fact 
that  unpleasant  incidents  have  occurred  during  its  use  it  should  be 
very  carefully  administered. 


PEPSIN.  499 

PEPSINUM— PEPSIN. 

Source. — Pepsin  is  obtained  by  digesting  the  mucous  mem- 
brane of  the  stomach  of  the  pig,  calf  or  sheep,  which  has  been 
scraped  off,  chopped  finely,  and  macerated  for  several  days  in 
water,  in  a  solution  of  muriatic  acid,  from  which  the  pepsin  is 
precipitated  with  chloride  of  sodium.  The  medicinal  preparation 
is  in  the  form  of  a  nitrogenized,  light,  amorphous,  grayish-white 
or  fawn-colored  powder,  soluble  in  water  and  alcohol,  and  of  a 
peculiar  odor,  and  bitter,  nauseous  taste.  When  quite  pure,  it  is 
both  tasteless  and  inodorous.  When  decomposed  by  heat  it  no 
longer  possesses  digestive  properties,  and  much  of  what  is  sold  is 
almost  or  wholly  inert.     Pure  pepsin  is  an  artificial  digestive. 

Medical  Properties  and  Action. — Pepsin  is  an  essential  consti- 
tuent of  the  gastric  juice,  and  digests  the  nitrogenous  constituents 
of  the  food,  converting  them  into  peptones.  Taken  internally, 
as  a  medicinal  preparation,  pepsin  increases  the  appetite  and 
allays  irritability  of  the  stomach.  It  should  be  administered 
immediately  before  meals,  and  no  hot  food  taken  for  some  time 
afterward. 

Therapeutic  Uses. — Pepsin  is  employed  in  dyspepsia,  gastralgia, 
obstinate  vomiting,  infantile  diarrhoea,  apepsia  of  infants,  vomit- 
ing of  pregnancy,  cancer  and  chronic  ulcer  of  the  stomach, 
anemia,  chlorosis,  atrophy,  etc.  Externally  it  is  injected  into 
cancerous  tumors  and  morbid  growths  with  the  hypodermic 
syringe,  to  retard  their  progress. 

Dose. — Of  pepsin  suspended  in  syrup,  saccharated  pepsin — 
Pepsinum  saccharatutn  gr.  v  to  gr.  x.  Syrup  of  orange  peel  will 
disguise  its  odor.  Vinum  Pepsini.  Dose,  oss  to  oj-  Glycerinum 
Pepsini.     Dose^  5ss  to  5j- 

Both  the  saccharated  pepsin  and  the  glycerole  are  unchange- 
able. 

Pepsin  appears  to  be  especially  efficient  in  cases  of  children ; 
and  when  pepsin  and  a  small  quantity  of  hydrochloric  acid  are 
added  to  animal  broths  given  by  the  rectum,  in  cases  where  food 
is  rejected  by  the  stomach,  such  nourishment  is  very  beneficial. 

Dental  Uses. — In  dental  practice,  pepsin  is  successfully  em- 
ployed in  the  treatment  of  putrid  pulps  of  teeth,  as  an  antiseptic 


500  DENTAL  MEDICINE. 


and  deodorizer.  In  the  form  of  a  thin  paste  made  by  mixing 
pepsin  with  water  containing  some  two  per  cent,  of  hydrochloric 
acid,  it  is  introduced  into  the  pulp  canal  after  the  removal  of  the 
decomposed  matter,  and  confined  by  a  temporary  filling  in  the 
crown  cavity,  being  permitted  to  remain  for  twenty-four  hours, 
when  it  is  removed  and  the  canal  syringed  with  tepid  water, 
and  if  necessary,  the  application  of  the  pepsin  paste  repeated 
until  the  odor  of  decomposition  can  no  longer  be  detected. 
Pepsin,  in  the  form  of  the  paste,  is  also  applied  to  partially  de- 
composed dentine,  which  may,  for  good  reasons,  be  permitted  to 
remain  immediately  over  the  pulp  of  the  tooth,  the  action  of  the 
pepsin  being  confined  to  dead  matter  alone.  The  hydrochloric 
acid  and  pepsin  paste  has  also  been  recommended  for  devitalizing 
the  pulps  of  teeth  where  rapid  action  is  not  desired,  the  quantity 
employed  being  about  one-fifteenth  of  a  grain. 

DENTAL    FORMULAE. 

For  Suppurating   Dental  Pulps.  ^o^  Indigestion. 

MlALHE. 

Oakley  Coles.  t>     t)      •  • 

R.    Pepsim jiss 

R.    Acidi  hydrochlorici    .  ITLJ  M"^ f^viss 

Aquae  destillate  .    .    .  Tltxl  Vini  xerici f^xiiss 

Pepsini   porci  .    .    .    .  q.  s.  Alcoholis f  3  iij 

Sacchari ^j 

SiGNA.— To  be  applied  to  suppurating       Signa.— A  tablespoonful   immediately 
PuJps-  after  each  meal. 

Ingluvin  is  a  ferment  prepared  from  the  gizzard  of  the 
chicken,  and  its  effects  are  analogous  to  those  of  pepsin.  It  is 
employed  internally  for  indigestion,  etc.,  and  to.  prevent  nausea 
and  vomiting. 

Dose. — Of  Ingluvin,  grs.  v  to  3j. 

.    PEROXIDE   OF   HYDROGEN— HYDROGEN  PEROXIDE. 
HYDROGEN     DIOXIDE. 

Formula. — H202. 

Derivation. — Peroxide  of  hydrogen  is  obtained  bv  rubbing  up 
peroxide  of  barium  with   distilled  water,  so  as  to   form  a  liquid 


PEROXIDE  OF  HYDROGEN.  50I 

paste,  which  is  added  gradually,  with  constant  stirring,  to  distilled 
water  acidulated  with  one-third  of  its  weight  of  hydrochloric 
acid,  contained  in  a  vessel  immersed  in  a  freezing  mixture. 
When  the  muriatic  acid  is  saturated,  a  fresh  quantity  of  the  acid 
in  a  concentrated  state  is  added,  and  then  more  of  the  peroxide 
of  barium,  and  the  operation  repeated  till  the  solution  will  hold 
no  more  chloride  of  barium,  which  is  deposited  by  a  mixture  of 
ice  and  salt,  except  a  small  portion  which  is  gotten  rid  of  by 
adding  sulphate  of  silver  to  precipitate  the  sulphate  of  baryta  and 
chloride  of  silver.  The  filtered  liquid  is  then  concentrated  by 
sulphuric  acid,  and  the  water  rising  in  vapor  is  absorbed  and 
protoxide  of  hydrogen  is  obtained  nearly  pure,  in  the  form  of  a 
colorless  liquid  of  a  fluid  consistence. 

L.  Crismer  explains  a  new  and  economic  process  for  preparing 
hydrogen  peroxide.  It  depends  upon  the  long-known  property 
of  sulphuric  ether  of  taking  up  and  dissolving  large  quantities  of 
H2O2.  Commercial  barium  oxide,  containing  from  85  to  90  per 
cent,  of  BaOj  is  treated  with  an  excess  of  hydrochloric  acid 
(i.io  specific  gravity),  and  the  solution  shaken  up  with  an  equal 
volume  of  ether.  The  mixture  is  let  stand  until  separation  has 
taken  place,  when  the  ether  is  drawn  off  and  agitated  with  dis- 
tilled water,  which  latter  removes  and  takes  up  all  the  hydrogen 
peroxide  which  the  ether  held  in  solution.  The  cleaned  ether  is 
separated  from  the  water,  and  is  again  shaken  with  the  solution 
of  barium  oxide,  and  again  extracted  with  the  distilled  water. 
The  operation  is  repeated  five  or  six  times,  by  which  the  ex- 
traction of  H2O2  is  complete.  The  aqueous  solution  will  then 
form  8  to  9  per  cent,  of  the  peroxide,  and  is  entirely  neutral  and 
free  from  solid  matter. 

Medical  Properties  and  Physiological  Action. — Peroxide  of  hydro- 
gen "  is  a  powerful  and  oxidizing  agent  on  account  of  its  un- 
stable nature,  as  it  immediately  reacts  with  and  destroys  sulphu- 
rated hydrogen,  and  many  other  compounds  susceptible  of  change. 
It  possesses  the  advantage,  sometimes  a  very  important  one,  that 
the  product  of  its  composition  (water)  is  neutral  and  destitute  of 
chemical  activity,  while  hydrogen  peroxide  itself  has  not  the  ex- 
treme tendency  to  act  on  inert  organic  matter  which  so  much  di- 


502  DENTAL  MEDICINE. 


minishes  the  practical  value  of  the  permanganates.  On  the 
other  hand,  hydrogen  peroxide  possesses  true  disinfectant  prop- 
erties of  a  marked  character."  Fibrin  and  cellular  tissue  cause 
it  to  evolve  oxygen,  while  albumen,  gelatin,  urea,  and  cutaneous 
tissue  have  no  effect  upon  it. 

Topically,  it  acts  by  imparting  oxygen  to  the  diseased  tissues, 
and  thus  destroying  them.  Bert  and  Reynard  found  that  soluble 
ferments  do  not  seem  to  be  affected  by  it ;  saliva,  diastase,  the 
gastric  and  pancreatic  fluids,  continue  to  act  in  solutions  contain- 
ing peroxide  of  hydrogen.  The  conclusions,  therefore,  that 
these,  as  well  as  Peau  and  Baldy,  have  arrived  at  are  that  per- 
oxide of  hydrogen,  even  when  very  dilute,  arrests  fermentation 
due  to  the  development  of  living  organisms,  and  the  putrefaction 
of  all  substances  whic*h  do  not  decompose  it;  that  containing, 
according  to  circumstances,  from  two  to  six  times  its  volume  of 
oxygen,  it  is  capable  of  advantageously  replacing  alcohol  and  car- 
bolic acid  j  that  it  can  be  employed  externally  for  dressing 
wounds  and  ulcerations  of  all  natures,  in  injections  and  in  vapor- 
izations, and  internally ;  that  the  results  obtained  in  the 
case  of  the  largest  operations,  up  to  the  present,  are  in  the 
highest  degree  satisfactory ;  that  not  only  fresh  wounds,  but 
old  ones,  proceed  rapidly  to  cicatrization,  and  reunion  by 
first  intention  appears  to  be  encouraged  by  its  use  as  a 
dressing;  that  the  general  as  well  as  the  local  state  appears  to  be 
favorably  influenced ;  that  the  advantage  over  carbolized  water 
are  its  not  having  any  poisonous  effect  nor  unpleasant  odor, 
while  its  application  is  entirely  painless.  It  is  an  effective  appli- 
cation in  a  large  class  of  diseases  in  which  mucous  membrane 
tissue  is  chiefly  affected,  and  for  cleansing  purposes  is  considered 
to  be  unequaled.  Dr.  Prince  remarks  that  a  drop  of  pus  will  de- 
compose peroxide  of  hydrogen  and  liberate  nascent  oxygen, 
which  adheres  to  and  attacks  all  the  adjacent  tissues  for  which  it 
has  an  affinity,  and  it  thus  becomes  a  powerful  bacterial  destroyer. 
Peroxide  of  hydrogen  for  surgical  use  must  be  entirely  neutral, 
as  that  obtained  generally  often  contains  sulphuric  acid,  so  that 
its  use  would  not  be  without  danger. 

Therapeutic    Uses. — Peroxide   of  hydrogen    is   employed   as  an 


PEROXIDE  OF  HYDROGEN.  503 

internal  reniedy  in  low  forms  of  fevers,  chronic  and  subacute 
rheumatism,  whooping-cough,  chronic  bronchitis,  dyspepsia,  as  it 
improves  digestion,  diabetes,  etc.,  etc.  Locally  employed,  it  is 
an  effective  antiseptic,  disinfectant,  and  a  powerful  deodorant 
owing  to  its  oxidizing  properties,  destroying  very  rapidly  hydro- 
gen, sulphur  and  similar  gases.  When  it  is  brought  in  contact 
with  pus,  a  rapid  change  takes  place,  with  evolution  of  oxygen 
gas,  the  pus-corpuscles  becoming  granular,  losing  form,  and 
breaking  up  into  detrius.  It  thoroughly  cleanses  putrid  cavities 
and  abscesses.  Owing  to  its  rapid  action,  however,  it  cannot 
take  the  place  of  bichloride  of  mercury,  nor  has  it  the  germi- 
cidal power  of  this  latter  agent,  although  it  possesses  such  proper- 
ties. As  a  bactericidal  agent,  it  is  very  serviceable  in  mi- 
crobic  affections  of  the  mouth  and  throat,  such  as  diphtheritic 
and  aphthous  stomatitis.  It  produces  little  or  no  irritation  when 
used  about  tender  organs,  and  can  be  successfully  applied  in  an 
unirritating  form,  so  that  it  comes  in  contact  with  and  destroys 
diseased  germs ;  hence  its  applicability  to  dental  uses,  and  in 
ocular  and  oral  therapeutics,  as  in  gonorrhoeal  ophthalmia  and 
mastoid  abscess,  for  example.  Peroxide  of  hydrogen  acts  very 
promptly  and  beneficially  in  feeble,  flabby  or  ill-conditioned 
ulcers,  chancre,  and  diphtheritic  sores,  ozaena,  wounds,  both 
fresh  and  putrid,  etc.,  etc.  Peroxide  of  hydrogen  appears  to 
have  no  injurious  effect  upon  animal  cells,  but  has  a  very  en- 
ergetic destructive  action  upon  vegetable  cells — microbes.  It 
has  no  toxic  properties,  and  is  also  harmless  when  given  by 
the  mouth.  It  is  especially  applicable  in  the  treatment  of  dis- 
eases caused  by  germs  if  the  microbian  element  is  directly  acces- 
sible, and  is  particularly  useful  in  the  treatment  of  infectious  dis- 
eases of  the  mouth  and  throat. 

To  obtain  the  best  results  from  peroxide  of  hydrogen,  it  should 
be  kept  in  a  cool  place,  tightly  stoppered,  and  when  required  for 
use  as  much  as  desired  should  be  poured  from  a  large  bottle  into 
a  small  receptacle,  and  only  the  quantity  to  be  used  at  a  time  be 
exposed  to  the  light.  For  injection,  a  small  glass  or  rubber 
syringe  should  be  used,  as  contact  with  metal  destroys  its 
utility. 


504:  DENTAL  MEDICINE. 


As  a  test  for  peroxide  of  hydrogen,  Dr.  Chas.  Mayr  suggests  a 
paper  saturated  with  a  mixed  solution  of  iodide  of  potassium  and 
dithionate  of  soda.  The  peroxide  of  hydrogen  liberates  the  iodine 
in  the  iodide  of  potash,  but  this  liberated  iodine  is  immediately 
seized  by  the  dithionate  of  soda  and  a  colorless  solution  is  the 
result.  But  if  enough  of  the  peroxide  is  applied  the  blue  spot  will 
appear,  because  more  iodine  is  liberated  than  can  be  used  in 
oxidizing  the  dithionate  of  soda  to  tetrathionate  of  soda;  to  make 
the  reaction  more  pronounced  still,  a  little  starch-paste  is  added. 
By  this  paper  one  drop  of  peroxide  of  hydrogen  of  12  volumes  of 
oxygen,  produces  a  blue  spot  in  20  seconds;  with  six  volumes  in 
from  one  to  two  minutes ;  and  with  four  volumes  no  blue  spot  is 
produced,  only  possibly  a  blue  rim. 

Dose. — Of  peroxide  of  hydrogen,  gr.  iij  to  gr.  v,  containing  six 
times  its  volume  of  oxygen,  or  two  per  cent.  In  operations  on 
mucous  membrane,  a  strong  solution  of  peroxide  of  hydrogen — 
twelve  per  cent. — greatly  facilitates  by  decolorizing  the  blood  and 
by  its  cleansing,  styptic  action. 

Dental  Uses. — Peroxide  of  hydrogen  is  a  valuable  remedy  in 
dental  therapeutics,  especially  in  the  treatment  of  alveolar  abscess, 
alveolar  pyorrhoea,  ulcerations  of  oral  mucous  membrane,  gan- 
grene or  cancrum  oris,  fungous  growths,  bleaching  discolored  teeth, 
putrescent  pulps,  stomatitis,  etc.,  etc. 

A  twenty  per  cent,  solution  has  been  recommended  for  the 
arrest  of  hemorrhage,  after  tooth  extraction,  by  Mr.  Bennett. 

Dr.  A.  H.  Prince's  method  of  treatment,  in  the  case  of  alveolar 
abscess,  illustrates  the  properties  of  peroxide  of  hydrogen.  "The 
septic  abscess  is  caused  to  heal  by  one  application  made  in  the 
following  manner:  After  removing  the  pulp  and  passing  a  broach 
through  a  canal  of  the  root  into  the  abscess  cavity  a  drop  of  the 
liquid  is  injected  by  means  of  Farrar's  syringe.  The  cavity  of  the 
crown  is  then  immediately  closed  with  softened  gutta  percha,  before 
which,  under  pressure  of  the  finger,  the  liquor  is  driven  into  the 
abscess  cavity.  Upon  coming  in  contact  with  the  pus  in  the  fetid 
cavity,  the  liberated  gas  permeates  it  throughout,  and  by  the  con- 
tinued evolution  of  the  gas  the  cavity  is  emptied  of  its  contents, 
which  boil  out  at  the  fistulous  opening  so  thoroughly  mixed  that 


PEROXIDE  OF  HYDROGEN.  505 

the  appearance  is  that  of  foam  or  froth  ;  while  the  remnant  thus 
removed  is  rendered  so  thoroughly  antiseptic  that  the  healing  proc- 
ess proceeds  uninterruptedly."  Dr.  A.  W.  Harlan  has  success- 
fully employed  the  peroxide  of  hydrogen,  in  connection  with  iodide 
of  zinc  solution  and  other  agents,  in  the  treatment  of  alveolar 
pyorrhoea. 

Dr.  Harlan's  treatment  is  as  follows  :  First  pack  the  pus  pockets 
with  iodoform  and  eucalyptus,  iodoform  and  oil  of  cinnamon,  or 
thoroughly  syringe  with  a  one  to  three  grain  solution  to  the  ounce 
of  water  of  chloride  of  alumina,  a  method  which  will  relieve  the 
suffering  and  reduce  the  swollen  gums  to  their  normal  size.  In 
three  or  four  days  the  sanguinary  deposits  may  be  removed,  and 
the  edges  of  the  alveolus  scraped  or  chiseled  off.  The  pockets  are 
then  syringed  with  peroxide  of  hydrogen,  and,  after  drying  the 
gums,  injected  with  one,  two  or  three  drops  of  a  solution  of  iodide 
of  zinc,  grs.  xii  to  the  ounce  of  water.  On  the  fourth  day  the 
gums  are  carefully  dried,  and  a  fine  cone  of  cotton  or  bibulous 
paper  moistened  with  peroxide  of  hydrogen,  gently  pressed  into 
each  pocket.  If  any  effervescence  occurs,  it  denotes  the  presence 
of  pus,  when  each  pocket  should  be  again  injected  with  the  iodide 
of  zinc  solution.  In  chronic  cases,  after  syringing  with  the  per- 
oxide of  hydrogen,  a  stronger  injection  of  the  iodide  of  zinc 
(grs.  xxiv  to  the  ounce  of  water)  is  made,  and  in  very  bad  or 
hopeless  cases  even  a  stronger  solution  of  the  zinc  (grs.  xlviii  to 
the  ounce  of  water) ;  and  when  the  gingiyal  margins  present  a 
ragged  border  or  cone-shaped  slit,  pure  granular  iodide  of  zinc  is 
applied  to  such  edges.  The  injection  into  the  pocket  is  repeated 
every  fourth  day.  In  some  cases  constitutional  treatment  is  also 
required.  Peroxide  of  hydrogen  has  also  been  successfully  used 
for  bleaching  discolored  teeth,  first  adjusting  the  rubber  dam  and 
repeatedly  washing  out  the  cavity  with  the  peroxide  of  hydrogen, 
and  then  carefully  drying  with  the  hot-blast  syringe.  A  small 
quantity  of  chloride  of  alumina  is  then  placed  in  the  cavity  and 
moistened  with  peroxide  of  hydrogen  and  allowed  to  remain  for 
five  minutes,  and  then  washed  out  with  a  clear  solution  of  sodze 
biboras. 


506  DENTAL  MEDICINE. 


DENTAL    FORMULA. 


Antiseptic  and  Stimulant  Mouth  Wash.  fgy  Alveolar  Fyorrhaa. 

For  use  in  Alveolar  Pyorrhoea, 
etc.,  etc. 
Dr.  Chas.  B.  Atkinson.  ^'  ^  rogen  perox.  .    .  ^j 


B .         Hydrogen  perox.  .    .   ?  iv 

T,.     ^        111  ■•      HT        SiGNA. — Inject  into  pockets  until  they 

Tinct.  calendulae  .    .  31J.     M.  . 

SiGNA. — Use  daily. 


Dr.  a.  W.  Harlan. 

hydrogen   perox.  .    .  J 
Hydrarg.  bichlor.  .    .  gr.^.  M. 

— Inject  into  pockets  unt 
are  free  of  all  foreign  matter. 


PEROXIDE  OF  SODIUM— SODIUM  PEROXIDE— SODIUM  DI-OXIDE. 

Formula. — NagOg. 

Derivation. — Sodium  Peroxide  is  obtained  by  adding  the  perox- 
ide of  hydrogen  to  an  excess  of  caustic  soda  solution  of  twenty 
per  cent.,  and  then  pouring  into  alcohol.  Chemically  considered, 
it  is  the  analogue  of  peroxide  of  hydrogen. 

Properties. — It  is  a  strongly  alkaline  and  caustic  white  solid, 
soluble  in  water,  when  it  produces  an  increase  of  temperature  and 
evolves  a  certain  amount  of  oxygen,  with  scarcely  any  loss  of  the 
latter  if  the  peroxide  of  sodium  is  added  to  the  water  in  small 
quantities  and  gradually  stirred  in  ;  when  the  solution  is  made 
hurriedly  by  the  addition  of  large  quantities  of  the  powder  to  the 
water  at  a  time,  the  evolution  of  heat,  due  to  the  energy  of  the 
combination,  causes  rapid  elevation  of  the  temperature  of  the 
solution  and  the  decomposition  of  the  peroxide. 

It  is  necessary  to  protect  this  preparation  of  sodium  from 
moisture,  and  if  exposed  to  the  air  its  weight  increases  twenty 
per  cent,  in  twenty-four  hours.  The  presence  of  water  and  con- 
tact with  organic  matter  produces  inflammation  in  such  matter, 
hence  it  is  necessary  to  handle  this  drug  with  care. 

Peroxide  of  sodium  very  closely  resembles  peroxide  of  hydro- 
gen in  the  readiness  with  which  it  separates  from  the  extra  atom 
of  oxygen  it  contains,  and  its  bleaching  property  depends  upon 
this  extra  atom  of  oxygen,  which,  when  liberated,  seizes  upon 
the  hydrogen  of  the  organic  color-compound,  thus  destroying  its 
identity.  While  peroxide  of  hydrogen  contains  but  three  or  four 
per  cent,  of  available  bleaching  oxygen,  peroxide  of  sodium  con- 
tains about  twenty  per  cent.,  and  as  a  bleaching  agent,  antiseptic, 


PEROXIDE  OF  SODIUM.  507 

disinfectant  and  sterilizer,  it  has  an  additional  advantage  over 
peroxide  of  hydrogen,  by  possessing  a  saponifying  and  solvent 
action  upon  the  oils,  fats  and  animal  tissue  present  in  the  denti- 
nal structure  of  the  teeth. 

On  account  of  its  being  freely  soluble  in  water,  and  uniting 
with  it  so  energetically  as  to  evolve  considerable  heat,  such  action 
can  be  controlled  by  adding  the  powdered  peroxide  of  sodium 
slowly  and  in  small  quantities  to  the  water,  which  should  always 
be  done  in  making  solutions,  as  decomposition  and  loss  of  oxygen 
result  when  such  care  is  not  taken,  and  the  solution  is  allowed  to 
become  hot.  A  standard  solution  can  be  reduced  to  any  desired 
strength  by  adding  definite  proportions  of  water.  Strong  solutions 
of  peroxide  of  sodium  are  powerfully  caustic  and  dissolve  animal 
tissue  and  saponify  oils  and  fats. 

Dental  Uses. — Peroxide  of  sodium  when  carefully  employed, 
has  proven  highly  successful  as  a  bleaching  agent  for  discolored 
teeth,  and  a  detergent  disinfectant  and  sterilizer  in  the  treatment 
of  putrescent  conditions  of  the  pulp  chamber  and  canals,  as  it 
penetrates  the  tubuli  and  dissolves  the  fibrils  as  well  as  the  fatty 
constituents.  Peroxide  of  hydrogen  contains  about  three  or  four 
per  cent,  of  available  oxygen,  while  peroxide  of  sodium  contains 
twenty  per  cent.,  and  in  addition  is  a  powerful  saponifier :  hence 
its  superiority  as  a  bleaching  agent.  A  solution  varying  in  strength 
from  full  saturation  to  one  containing  about  five  per  cent,  of  the 
saturated  solution,  has  been  employed  by  Dr.  E.  C.  Kirk  in  the 
treatment  of  pulpless  teeth  with  putrescent  canal-contents,  and 
especially  in  such  cases  where  the  whole  structure  of  the  dentine 
was  permeated  and  colored  by  an  offensive  and  fermenting  mass 
of  decomposing  organic  matter,  with  often  a  blind  abscess  as  an 
accompaniment  to  add  to  the  foulness  present,  with  satisfactory 
results.  He  recommends  flooding  the  pulp-chamber  and  canals 
with  a  fifty  per  cent.,  or  even  a  saturated  solution,  of  peroxide 
of  sodium,  with  the  rubber-dam  in  position  to  prevent  contact  of 
the  solution  with  the  soft  tissues  of  the  mouth,  the  activity  of  the 
preparation  being  at  once  shown  bv  the  evolution  of  gas  similar 
to  the  action  of  peroxide  of  hydrogen,  but  with  less  violence  and 
rapidity.     Peroxide  of  sodium  is  also  very  effective  as  a  bleach- 


508  DENTAL  MEDICINE. 


ing  agent  for  carious  and  discolored  dentine.  For  bleaching  pur- 
poses, Dr.  Kirk  recommends  saturating  the  dentine  with  a  strong 
solution  of  peroxide  of  sodium  (50  per  cent.),  following  this  by 
treatment  with  a  dilute  acid,  such  as  hydrochloric,  sulphuric  or 
acetic,  or  a  ten  per  cent,  solution  of  trichloracetic  acid ;  the  pref- 
erence is  given  to  hydrochloric.  In  addition  to  such  properties, 
peroxide  of  sodium  completely  sterilizes  the  dentine  by  acting  as 
a  mechanical  cleanser,  and  a  solvent  of  the  organic  debris  and 
fats,  in  the  form  of  small  shreds  of  pulp-tissue  and  organic  matter 
in  a  partially  decomposed  state.  Dr.  Kirk  also  recommends, 
after  the  application  of  the  peroxide  of  sodium,  inserting  into  the 
canals,  for  a  moment  on  cotton,  a  diluted  solution  of  hydrochloric 
or  sulphuric  acid,  afterward  washing  and  drying  with  hot  air, 
and  then  immediately  filling  them.  For  the  upper  teeth  he 
recommends  that  the  application  of  the  solutions  be  in  pledgets 
of  asbestos  fibre,  as  the  cotton  is  rapidly  disintegrated  by  strong 
solutions. 

Dr.  Harold  Clark  describes  his  method  of  preparing  a  saturated 
solution  of  peroxide  of  sodium  as  follows  : 

"  I  put  two  ounces  of  distilled  water  in  a  small  four  ounce 
lemonade  glass  and  prop  it  up  in  a  basin  of  water  so  that  the  level 
of  the  water  in  the  glass  be  just  below  the  level  of  the  rim  of  the 
basin.  I  place  the  latter  under  the  cold  water  tap  so  that  a  small 
stream  may  run  continuously  into  the  basin  about  the  glass.  In 
this  way  its  contents  are  prevented  from  rising  in  temperature. 
The  violent  reaction  occurring  when  peroxide  of  sodium  is  put  in 
water,  raises  the  temperature  of  the  water,  driving  off^  the  oxygen 
which  we  desire  to  retain  in  the  solution.  By  surrounding  the 
glass  with  cold  water  and  sifting  the  peroxide  of  sodium  in  small 
quantities  every  half  hour  until  the  solution  becomes  semi- 
opaque  we  obtain  in  the  course  of  two  or  three  days  a  saturated 
solution." 

Dr.  L.  P.  Van  Woert  suggests  the  following  method  of  pre- 
paring a  satisfactory  solution  of  peroxide  of  sodium  :  "Take  a 
common  tumbler  about  half  full  of  distilled  water,  place  it  in  the 
centre  of  a  good-sized  pudding-dish,  and  pour  all  the  cold  water 
around   it  possible,  without  floating  the  glass.     Add  the  sodium 


PHENACETINE.  509 


peroxide  in  very  small  portions — about  what  could  be  taken  upon 
the  point  of  the  large  blade  of  a  pocket-knife — dusting  in  the 
water  slowly  to  cause  as  little  agitation  as  possible,  and  this 
amount  should  not  be  added  oftener  than  once  in  a  half  hour, 
being  careful  to  have  the  sodium  peroxide  finely  powdered.  This 
to  be  continued  until  the  preparation  begins  to  look  opaque  as 
powder  is  added.  Let  it  stand  over  night  and  it  is  then  ready 
for  use.  If  a  lump  about  the  size  of  a  small  bean  is  dropped  into 
water,  you  will  notice  on  the  margin  of  the  line  of  agitation  a 
ring  of  color  resembling  iodine.  If  the  peroxide  is  put  in  the 
water,  as  I  have  suggested,  there  will  be  very  little  surface  agita- 
tion and  none  of  the  discoloration,  the  result  of  which  is  a  solution 
that  has  never  failed.  This  takes  several  days  to  make,  but  it 
will  more  than  pay  for  the  time  consumed,  in  its  prompt  action 
as  a  bleacher  and  sterilizer.  I  have  placed  this  solution  in  the 
hands  of  a  number  of  gentlemen,  to  be  used  in  the  treatment  of 
abscessed  roots,  and  up  to  the  writing  of  this  not  a  single  failure 
has  been  reported.  The  general  impression  is  that  sodium  peroxide 
is  for  bleaching  only,  while  it  is  the  most  valuable  preparation 
ever  found  for  the  treatment  of  dead  teeth,  if  used  in  the  follow- 
ing manner  :  Cleanse  the  root-canals  of  such  septic  matter  as  pos- 
sible to  get  at  with  instruments,  and  dry  them  with  hot  air ;  then 
carry  small  ropes  of  cotton,  saturated  with  a  full  strength  solution, 
as  near  the  foramen  as  you  can,  using  orange-wood,  shaped  like  fine 
probes,  and  cover  with  a  temporary  stopping,  letting  the  whole 
remain  for  two  days,  after  which  wash  with  hot  water,  and  fill  in 
the  usual  manner."  When  peroxide  of  sodium  is  introduced  into 
a  pulp-canal  a  chemical  reaction  takes  place,  and  like  peroxide  of 
hydrogen,  it  is  an  active  oxidizer  from  the  facility  with  which  it 
parts  with  one  atom  of  oxygen  ;  it  is  also  a  saponifier  and  solvent 
of  the  pulp  tissue,  and  of  oils  and  fats.  Its  effects  on  the  fibrils 
are  to  dissolve  and  saponify  them  as  a  bleaching  agent,  for  its 
action  far  into  the  dentinal  tubuli. 

PHENACETINE— PARAACETPHENITIDINE. 

Formula.— C,,H,,1^0,=C,H,—{0C,H,)'NH{C2H,0). 
Medical    Properties    and     Therapeutic     Uses. — Phenacetine     is 


510  DENTAL  MEDICINE. 


slightly  soluble  in  water,  but  freely  soluble  in  alcohol,  and  has 
proven  to  be  a  most  reliable  antineuralgic  without  deleterious 
effects.  It  causes  no  nausea,  vomiting  or  diarrhoea;  no  collapse, 
no  cyanosis,  or  depressing  after-effects.  It  is  thought  to  pro- 
duce its  effects  by  slowly  dissolving  in  the  lactic  acid  of  the 
stomach. 

Prof.  Rumpf  considers  phenacetine  to  be  not  a  narcotic,  but  an 
antineuralgic  acid  from  its  strong  antipyretic  action. 

The  mode  of  action  is  probably  a  direct  influence  on  the  cen- 
tral nervous  system — that  of  the  vaso-motor  more  especially,  for 
phenacetine  acts  especially  on  the  vaso-motor  neuroses,  which 
indicates  a  powerful  effect  on  the  circulation.  Phenacetine  is  a 
strong  analgesic,  and  thought  to  be  more  powerful  in  its  action 
than  either  antipyrine  or  antifebrin,  and  it  acts  very  rapidly  not- 
withstanding its  insolubility  in  the  gastric  juice.  About  twenty 
minutes  after  its  administration  its  effects  may  be  observed.  It 
is  employed  in  the  various  forms  of  neuralgia,  hemicrania,  acute 
rheumatism,  vaso-motor  neuroses,  neurasthenia,  locomotor  ataxia, 
etc.,  etc. 

Dose. — As  an  antineuralgic  the  dose  ranges  from  eight  to 
twenty-two  and  a  half  grains  (one-half  to  one  and  one-half 
grams).  Fifteen  grains  is  the  average  dose.  Good  results  are 
obtained  by  administering  phenacetine  in  gr.  v  doses,  once  in  an 
hour  until  gr.  xv-xx  are  taken. 

Dental  Uses. — Phenacetine  is  employed  in  neuralgias  of  dental 
origin,  acute  periodontitis,  and  pericemental  irritation. 


PHENALGIN. 


Formula — C6H5,NH2. 


Derivation. —  Phenalgin  is  a  synthetic  coal-tar  product  which 
may  be  chemically  described  as  a  compound  product  of  the 
amido-benzine  series.  The  ammonia  is  liberated  in  the  stomach 
in  a  nascent  state,  and  tends  to  neutralize  and  antagonize  the  de- 
pression which  usually  follows  the  administration  of  antipyretic 
products.  It  occurs  as  a  white  powder  with  an  odor  of  am- 
monia. 

Medical  Properties   and  Physiological  Action. — It  is  claimed  that 


PHENATE  OF  COCAINE.  51 1 


it  exerts  a  stimulating  effect  on  the  heart,  and  that  in  doses  of 
ten  grains  and  upward,  a  sedative  effect  is  produced  in  addition 
to  its  analgesic  actions  on  the  sensory  apparatus  of  the  nervous 
system. 

The  stimulating  effect  of  the  ammonia  constituent  is  first  per- 
ceived, and  this  is  soon  followed  by  a  soothing  sensation,  due  to 
the  gradual  subsidence  of  the  painful  manifestations.  It  has  no 
toxic  properties. 

Therapeutic  Uses. — It  is  claimed  for  phenalgin  that  it  is  hyp- 
notic, anodyne,  analgesic,  antipyretic,  antiperiodic.  It  is  em- 
ployed in  all  painful  affections,  such  as  neuralgia,  rheumatism, 
gastralgia,  painful  menstruation,  headache,  effects  of  dissipation, 
migraine,  influenza,  insomnia,  etc.,  for  its  anodyne  and  hypnotic 
properties. 

Dose. — Of  phenalgin,  gr.  v  to  xx.  It  is  administered  in  the 
form  of  tablets  or  in  powder. 

Dental  Uses. — Phenalgin  is  serviceable  in  facial  neuralgia,  es- 
pecially in  neuralgias  of  the  fifth  nerve,  the  pain  of  periodontitis, 
and  alveolar  abscess,  pulpitis.  Dr.  A.  S.  Atkinson  states  that 
permanent  relief  from  painful  alveolar  abscess  of  two  weeks' 
standing  was  obtained  within  one  hour  after  prescribing  phenal- 
gin. 

PHENATE  OF  COCAINE— CARBOLATE  OF  COACINE. 

Derivation. — Phenate  of  cocaine,  as  prepared  by  Merck,  is,  as 
its  name  implies,  a  combination  of  carbolic  acid  and  cocaine 
containing  seventy-five  per  cent,  of  the  cocaine  alkaloid.  It  is  a 
slightly  colored  substance,  of  the  consistence  of  thick  honey,  and 
possesses  both  antiseptic  and  anaesthetic  properties.  Hydro- 
chlorate  of  cocaine  is  open  to  the  serious  objection  that  when 
applied  to  cut  surfaces  it  causes  dangerous  systemic  effects  en- 
dangering the  life  of  the  patient,  and  has  in  a  limited  number  of 
cases,  it  is  asserted,  caused  death.  The  phenate  of  cocaine,  on 
the  other  hand,  containing  the  alkaloid,  is  not  so  prone  to  cause 
symptoms  of  cocaine  poisoning  or  any  bad  after-effect.  It  is  sol- 
uble in  alcohol  of  from  thirty  to  fifty  per  cent.,  such  a  solution 
possessing  a  faint  odor  of  carbolic  acid. 


512  DENTAL  MEDICINE. 


Therapeutic  Uses. — Dr.  D.  B.  Kyle  regards  phenate  of  cocaine 
to  be  as  good  a  local  anaesthetic  as  the  muriate  of  cocaine,  and 
devoid  of  the  dangerous  systemic  effects  of  the  latter.  The  phe- 
nate of  cocaine  has  been  employed  successfully  in  cases  of 
cardiac  disease  and  albuminuria,  conditions  which  contra-indicate 
the  use  of  muriate  of  cocaine.  It  is  also  claimed  to  be  equal  to 
any  carbolized  solution  for  its  antiseptic  properties.  It  can  be 
safely  used  on  cut  surfaces.  Another  advantage  claimed  for  the 
phenate  over  the  muriate  of  cocaine  is  that  it  coagulates  the  al- 
bumen in  the  tissue,  preventing  the  absorption  of  the  cocaine, 
thereby  prolonging  the  anaesthetic  effect,  although  the  length  of 
time  necessary  to  produce  anaesthesia  is  somewhat  longer  than 
that  required  for  the  hydrochlorate  of  cocaine.  Phenate  of 
cocaine  is  employed  locally,  internally,  hypodermically,  and  in 
powder. 

Dose. — The  dose  of  phenate  of  cocaine  is  from  J^  to  ^  of  a 
grain.  Hypodermically  for  operations  involving  the  deeper 
tissue,  the  eight  or  ten  per  cent,  solution  will  usually  produce 
sufficient  anaesthesia,  although  it  may  be  applied  locally  in  a  fifty 
per  cent,  solution,  the  strength  in  which  it  is  sold  in  alcoholic 
solution  for  convenience  of  dilution.  In  solution  of  the  strength 
of  50  per  cent,  it  will  coagulate  albumen,  and  when  topically  ap- 
plied to  a  mucous  surface,  such  a  strength  may  cause  a  slight 
slough,  which  may  be  avoided  by  applying  glycerine  to  the  dried 
surface  before  applying  the  phenate  of  cocaine.  The  50  per 
cent,  solution  may  be  diluted  to  any  extent  desired  by  adding  to 
it  equal  parts  of  alcohol  and  water.  When  diluted  to  a  25  per 
cent,  solution  its  power  to  coagulate  albumen  is  overcome. 

Dental  Uses. —  Phenate  of  cocaine  is  employed  as  a  local  anaes- 
thetic for  the  extraction  of  teeth,  and  when  employed  in  a  50  per 
cent,  strength  or  diluted,  it  is  applied  to  the  gum,  previously 
dried,  about  the  tooth,  on  a  pledget  of  cotton,  which  is  allowed 
to  remain  for  from  three  to  five  minutes,  and  repeated  if  the 
anaesthesia  is  not  sufficient.  As  in  the  use  of  all  other  local 
anaesthetics  applied  to  the  mouth,  the  patient  should  be  cautioned 
not  to  swallow  during  the  operation,  to  avoid  the  benumbing 
effect  on  the  throat.     Phenate  of    cocaine  is  also  used  locally 


PHOSPHATES  AND  PHOSPHITES.  513 

for  opening  alveolar  abscesses,  treating  exposed  pulps,  for  sen- 
sitive dentine,  removing  tumors,  hypertrophy  of  tonsils  (care- 
fully applied),  chronic  and  specific  ulcers,  earache,  removal  of 
polypi,  hypertrophic  growths,  and  other  obstructions,  etc.  It  is 
claimed  for  phenate  of  cocaine  that  it  not  only  relieves  pain,  but 
checks  the  progress  of  the  disease. 

PHOSPHATES  AND  PHOSPHITES. 

The  Phosphates  are  ingredients  of  most  of  the  animal  and 
vegetable  foods,  and  a  sufficient  amount  of  phosphorus  is,  under 
normal  conditions,  appropriated  by  digestive  action  for  the  supply 
of  the  system.  Every  part  of  the  body  contains  phosphate  of 
lime  ;  and  rickets,  softening  of  the  bones  and  defective  teeth  re- 
sult when  too  little  is  supplied  during  the  formative  period.  The 
blood,  saliva,  gastric  juice,  urine,  milk  and  the  entire  intercellular 
fluid  contain  phosphate  of  lime  in  solution.  When  this  agent  is 
administered  by  the  stomach,  diffusion  into  the  blood  results  as  a 
consequence  of  its  being  to  some  extent  soluble  in  lactic  and 
hydrochloric  acids  ;  hence  it  is  very  essential  to  the  nutrition  of 
the  body,  and  small  doses  are  as  effective  as  large  ones,  as  all  in 
excess  of  the  quantity  soluble  in  the  acids  of  the  stomach  is  not 
appropriated,  but  passes  off  or  forms  concretions  in  the  intestines. 
Phosphate  of  sodium  is  also  a  constituent  of  the  blood,  and  by 
removing  morbid  states  of  the  mucous  membrane  it  promotes  di- 
gestion and  improves  nutrition  and  the  tone  of  the  nervous  sys- 
tem. Large  doses,  on  the  other  hand,  when  administered  in 
health,  will  impair  digestion.  Phosphorus  exists  generally  as  a 
phosphate,  and  has  a  strong  affinity  for  oxygen,  compounds  being 
rapidly  formed  in  the  stomach  ;  but  some  of  it  may  enter  the 
blood  uncombined.  It  is  a  powerful  irritant  poison,  the  dose  be- 
ing no  larger  than  ^i^  to  ^\  of  a  grain. 

The  preparations  of  the  Phosphates  and  Phosphites  are : 

Syrupus  Calcii  Lacto-phosphatis. — Syrup  of  the  lacto-phosphate 
of  lime.  Dose. — foj  to  f^j.  (See  Syrup  of  lacto-phosphate  of 
lime.) 

Compound  Syrup  of  the  Phosphates. — Each  drachm  contains 
33 


514  .  DENTAL  MEDICINE. 


two  and  a  half  grains  of  phosphate  of  iron  and  one  grain  of 
phosphate  of  lime. 

Sodii  Phosphas — Phosphate  of  Sodium. — In  the  form  of  large, 
colorless,  transparent  prisms,  with  a  cooling  saline  taste,  feebly 
alkaline  and  no  odor,  and  a  slightly  alkaline  reaction.  Soluble 
in  six  parts  of  water  at  60°  F.,  apd  in  two  parts  of  boiling  water. 
Dose. — f5j  to  f5j. 

Calcii  Phosphas  Pracipitatus. — Precipitated  Phosphate  of  Lime. 
In  the  form  of  a  white  powder,  with  no  taste  or  odor,  and  insol- 
uble in  water  or  alcohol.     Dose. — Gr.  ij  to  gr.  v. 

Syrupus  Hypophosphitum. — Syrup  of  Hypophosphites.  Com- 
posed of  hypophosphites  of  calcium,  sodium  and  potassium. 
Dose. — foj. 

Sodii  Pyrophosphas. — Pyrophosphate  of  Sodium.  In  the  form 
of  colorless,  translucent  prisms,  with  a  cooling  saline  taste  and 
a  feeble  alkaline  reaction,  but  no  odor,  soluble  in  water,  but  in- 
soluble in  alcohol.     Dose. — foss  to  fiSss. 

Calcii  Hypophosphis. — (See  Hypophosphite  of  Lime.) 

Sodii  Hypophosphis. — Hypophosphite  of  Sodium.  In  the  form 
of  small,  colorless  or  white  prisms,  or  a  white  granular  powder 
with  a  sweetish  saline  taste,  and  a  neutral  reaction,  and  soluble  in 
water.     Dose. — Gr.  v  to  gr.  x. 

Therapeutic  Uses. — The  phosphates  are  useful  in  rickets,  mol- 
lities  ossium,  non-union  of  fractures,  soft  teeth  of  children,  caries 
and  necrosis  of  bone,  anemia  of  nursing  mothers,  chronic  bron- 
chitis, leucorrhoea.  The  phosphate  of  soda  in  bilious  sick  head- 
ache, hepatic  colic,  jaundice,  carbuncles,  boils,  etc.,  etc.  The  hy- 
pophosphites in  phthisis,  emphysema,  fibroid  lung,  chronic  tuber- 
culosis, dilated  bronchi,  skin  diseases,  and  all  diseases  character- 
ized by  mal-nutrition.  Phosphoric  and  hypophosphoric  acids  are 
frequently  combined  with  many  vegetable  and  mineral  tonics. 
The  hypophosphites  fulfill  nearly  all  the  indications  of  phosphorus 
itself. 

PINUS  CANADENSIS— ABIES   CANADENSIS. 

Hemlock,  hemlock  spruce  of  the  United  States  and  Canada. 
The  medicinal   portions   are   the  juice  and  bark.     The  concrete 


JAMAICA  DOGWOOD.  515 

juice,  which  is  known  as  Fix  Canadensis — Canada  pitch,  is  a  yel- 
lowish or  faintly  greenish,  transparent,  viscid  liquid,  when  fresh, 
but  afterward  becomes  an  opaque,  reddish-brown,  hard  and  brittle 
mass,  which  contains  resin  and  a  volatile  oil.  It  is  used  to  make 
rubefacient  plasters.  The  bark  is  rough  and  deeply  furrowed, 
and  is  very  astringent,  possessing  properties  similar  to  those  of 
the  white-oak  bark.  An  extract  prepared  from  the  bark  is  used 
as  a  topical  astringent,  but  it  is  not  considered  to  have  any  ad- 
vantages over  other  common  vegetable  astringents  : 

For  Ivjiained  Mucous  Membrane,  and  for  Use  after  the  Removal 

of  Salivary   Calculus. 

A.   W.   Harlan. 

U.     Pinus  canadensis  (white) ^ss 

Aquae    Rosae J  iijss 

Eugenol Hl"^''' 

SiGNA. — Use  as  a  lotion  or  on  a  tooth-brush,  3  times  daily. 

PISCIDIA   ERYTHRINA— JAMAICA  DOGWOOD. 

Source. — Jamaica  Dogwood  is  a  plant  indigenous  to  the  West 
Indies,  where  it  has  been  used  as  an  intoxicant  in  taking  fish. 
The  bark  is  the  officinal  portion,  and  is  smooth  and  bright- 
colored. 

Medical  Properties  «Wy/t//5«.-— Jamaica  dogwood  is  a  powerful 
narcotic,  and,  in  a  measure,  tonic  and  diuretic.  Its  narcotic  prop- 
erties are  supposed  to  be  superior  to  opium,  as  it  does  not  cause 
the  disagreeable  after-effects  common  to  that  drug.  When  chewed, 
Jamaica  dogwood  has  an  unpleasant,  acrimonious  taste.  It  yields 
its  virtues  to  alcohol,  but  not  to  water.  Its  internal  use  is  gen- 
erally followed  by  a  sensation  of  heat,  gradually  extending  to  the 
surface,  and  succeeded  by  profuse  perspiration,  with  profound 
sleep.  In  large  doses  it  produces  general  paralysis,  and  death 
from  asphyxia.  It  has  been  used  as  a  substitute  for  morphine, 
which  it  resembles  in  many  respects. 

Therapeutic  Uses. — The  principal  use  of  Jamaica  dogwood  is 
in  neuralgia,  in  the  form  of  a  tincture  composed  of  Jamaica  dog- 
wood oj,  rectified  spirits  fsiv.  It  is  effectual  in  acute  pains  usu- 
ally, and  is  said  to  be  efficacious  in  lunacv,  and  cough  of 
phthisis. 


516  DENTAL  MEDICINE. 


Dose. — Of  the  tincture  of  Jamaica  dogwood,  foj. 

Dental  Uses. — Jamaica  dogwood,  in  the  form  of  the  tincture, 
is  efficacious  in  trigeminal  neuralgia,  and  in  odontalgia  resulting 
from  an  irritable  pulp,  for  which  purposes  a  fluid  drachm  in  cold 
water  may  be  taken  internally,  and  applied  externally  in  the  case 
of  odontalgia,  being  introduced  on  a  pledget  of  cotton  into  the 
carious  cavity. 

PLUMBI  ACETAS— ACETATE  OF  LEAD. 
SUGAR  OF  LEAD. 

Formula.— ?h{C^\^O^o^  +  ^\l^O. 

Derivation. — Acetate  of  Lead  is  obtained  by  immersing  lead  in 
distilled  vinegar,  or  litharge  in  pyroligneous  or  crude  acetic  acid  ; 
when  the  acid  has  become  saturated,  the  solution  is  permitted  to 
cool  and  crystallize. 

Acetate  of  lead  is  a  white  salt,  in  the  form  of  beautiful  brilliant, 
needle-shaped  crystals,  like  long  prisms,  which  effloresce  on  ex- 
posure to  the  air.  It  has  a  sweet,  astringent  taste,  and  an  odor 
of  acetic  acid,  and  is  soluble  in  water  and  alcohol. 

Medical  Properties  and  Action. — Acetate  of  lead  is  sedative  and 
astringent,  checking  the  secretions  and  reducing  the  activity  of 
the  capillary  system,  and  diminishing  the  force  and  frequency  of 
the  pulse.  Like  all  the  salts  of  lead,  it  is  an  irritant  and 
corrosive  poison,  causing  gastro-enteric  inflammation.  It  requires, 
however,  a  large  quantity  (not  less  than  half  an  ounce)  of  the 
acetate  of  lead  to  destroy  life,  as  much  of  it  is  rejected  by  vomit- 
ing. The  symptoms  of  lead  poisoning,  when  the  lead  is  slowly 
introduced  into  the  system,  are  loss  of  appetite  and  strength, 
wasting  of  flesh,  paleness  of  the  face,  constipation,  pain  in  the 
joints,  dry  colic,  which  is  relieved  by  pressure,  neuralgia  of  the 
abdominal  muscles,  contraction  of  the  intestines,  belly  drawn 
toward  the  spinal  column,  contraction  of  the  liver,  jaundiced  skin, 
yellow  conjunctiva,  urine  colored  with  biliary  coloring  matter,  a 
blue  line  along  the  margin  of  the  gum,  about  the  incisor  teeth ; 
also  at  times  a  bluish  discoloration  of  the  mucous  membrane  of 
the  lips  and  mouth,  dimness  of  vision,  paralysis  of  the  extensor 


ACETATE  OF  LEAD.  517 


muscles  of  the  fingers  and  arms,  death  resulting  from  the  gradual 
failure  of  nutrition  and  the  paralysis  of  the  muscles  of  respiration. 

When  the  poisonous  dose  is  large,  there  is  intense  gastric  irrita- 
tion, numbness,  paralysis,  coma  and  collapse.  Iodide  of  potassium 
in  large  doses,  also  Epsom  salts  and  sulphur  baths,  are  the  antidotes 
in  chronic  cases  of  lead  poisoning,  and  for  the  lead  colic,  alum  in 
doses  of  one  or  two  drachms  every  three  or  four  hours,  dissolved 
in  some  demulcent  liquid,  is  considered  to  be  the  best  remedy. 
For  the  treatment  of  lead  paralysis,  strychnia  and  electricity  are 
employed.  The  blue  or  slate-colored  line  on  the  gums  is  sup- 
posed to  be  due  to  a  deposition  of  the  sulphide  of  lead. 

Therapeutic  Uses. — Acetate  of  lead  is  internally  administered  in 
dysentery,  diarrhoea,  cholera,  cholera  morbus,  phthisis,  chronic 
bronchitis,  pneumonia,  diseases  of  the  heart,  hemorrhage  from  the 
lungs,  stomach,  kidneys,  nose,  etc. ;  diseases  of  the  eye,  erysipelas, 
skin  diseases,  chronic  gastric  catarrh,  gastralgia,  pyrosis,  summer 
diarrhoea  of  children,  humid  asthma,  whooping-cough,  etc. ;  but 
the  danger  of  producing  toxic  effects  must  be  remembered  in  its 
internal  use. 

Externally,  solutions  of  lead  are  employed  to  relieve  superficial 
inflammations,  arrest  morbid  discharges,  and  allay  the  pain  of 
acute  inflammations.  Lead  should  not  be  given  with  natural 
waters  containing  lime,  carbonic  acid,  mineral  acids  and  salts, 
vegetable  acids  or  vegetable  astringents,  iodide  of  potassium  and 
preparations  of  opium. 

Dose. — Of  plumbi  acetas,  gr.  ss  or  j  to  gr.  v,  two  or  three  times 
a  day. 

Liquor  Plumbi  Subacetatis  Dilutus — Diluted  Solution  of 
Subacetate  of  Lead. — Lead  water  is  composed  of  subacetate  of  lead 
solution,  f.3ij  ;  distilled  water,  Oj  ;  and  is  a  mild  astringent  and 
sedative  when  applied  externally  ;  it  is  never  prescribed  internally. 
It  arrests  discharges  from  suppurating  and  ulcerated  mucous  sur- 
faces, and  promotes  the  resolution  of  acute  superficial  inflamma- 
tions. 

Dental  Uses. — Lead  water  is  employed  in  dental  practice,  to 
relieve  inflamed  gums  and  mucous  membrane  of  the  mouth  ;  as 
an  application  to  indolent  and  foul  ulcers  ;  also  in  the  treatment 


518 


DENTAL  MEDICINE. 


of  teeth  after  the   devitalization   and    removal  of  the  pulps,  to 
prevent  peridental  trouble. 

It  proves  serviceable  when  applied  to  chapped  hands  and  lips. 
A  good  ointment  for  such  a  purpose  is  composed  of  a  combina- 
tion of  lead  w^ater,  camphor,  white  wax  and  oil  of  almonds. 


DENTAL    FORMULAE. 


For  Acute  Inflammation  of  the  Mucous 
Membrane    of  the  Mouth  and   the 
Guvis. 
R.       Plumbi  acetatis  .    .    .    .  ^j 

Tinct.  opii ^^  ss 

Aquae ^  x.  M. 

SiGNA. — Apply  as  a  lotion,  on  lint. 

For  Periodontitis. 
McQuiLLEN. 

R.       Liq.    plumbi     subace- 

tatis ^ij 

Tinct.  opii  .    .        .    .  ^ij.      M. 

SiGXA. — Apply  to  cavity  on  cotton  and 
to  gum  externally. 

Collyrium. 

Dr.  Gross. 

R.      Liq.    plumbi  subace- 

tatis 3J 

Tinct.   opii ^j 

Aquae,  q.s.ad ^  viij.   M. 

Fiat  lotio. 
SiGNA. — Use  as  a  lotion. 


For  Chapped  Hands  and  Lips. 
R .       Liq.    plumbi   subace- 

tatis    dilutus  .    .    ■   5  vj 
Camphorae    ....    gr.xl 
Cerae  albae  ....  5  viij.     M. 
Olei  amygdalae  dulcis  Oj. 
Fiat  cerat. 
SiGNA. — Apply  as  an  ointment. 

For  Inflamed  Gums  and  After  Tooth 

Extraction. 
R.       Plumbi  acetatis  .    .    .  gr.xv 

Tinct.  opii f^ij 

Aquae f^iij.  M. 

SiGNA. — Use    as  a  lotion  and    mouth 
wash. 

Collyrium. 
Dr.  Sturgis. 
R .       Liq.  plumbi  subacetatis, 

Tinct.  opii aa^j 

Aquae,  q.s.ad.    .    .    .   ^  viij.    M. 
Fiat  lotio. 
Signa. — Use  as  a  lotion. 


POTASSA  CAUSTICA— CAUSTIC  POTASH. 
HYDRATE    OF     POTASH FUSED    POTASH OXIDE    OF     POTASSIUM. 

Formula.— YiOY{. 

Derivation. — Caustic  Potash  is  prepared  by  boiling  a  solution 
of  potash  until  ebullition  ceases,  and  the  potassa  melts  or  assumes 
a  solidified  consistence,  when  it  is  poured  into  suitable  moulds 
and  kept  in  well-stoppered  bottles,  as  it  rapidly  deliquesces  when 


CAUSTIC  POTASH.  519 


exposed  to  the  air.  It  dissolves  in  water  and  alcohol,  and  attracts 
moisture.  Its  officinal  form  is  that  of  sticks  of  a  white  and 
somewhat  transparent  color,  but  upon  exposure  to  the  air,  or  if  it 
is  impure,  it  becomes  a  dingy  gray,  greenish  or  bluish  color,  and 
has  the  odor  of  slaking  lime.  When  it  is  digested  in  alcohol,  so 
as  to  free  it  from  such  impurities  as  are  insoluble  in  alcohol,  it 
is  called  alcoholic  poiassa. 

Medical  Properties  and  Action. — Caustic  Potash  is  the  most 
powerful  caustic  and  escharotic  in  use,  and,  when  taken  internally, 
is  a  corrosive  poison.  It  is  only  employed  externally.  When 
applied  to  a  part,  it  rapidly  destroys  its  vitality  to  a  considerable 
depth,  differing  in  this  respect  from  nitrate  of  silver  (lunar  caustic), 
as  the  latter  is  more  limited  in  its  action,  and  does  not  liquefy 
when  it  comes  in  contact  with  the  tissues.  From  the  penetrating 
action  of  caustic  potash,  it  is  necessary  to  use  it  with  great  care. 
It  is  very  deliquescent,  which  is  a  great  objection  to  its  use  in 
some  cases,  but  when  mixed  with  an  equal  quantity  of  lime,  the 
deliquescent  action  is  in  a  measure  prevented;  it  is  then  known 
as  potassa  cum  cake — potassa  with  lime,  and  is  in  the  form  of  a 
grayish-white  powder,  which  is  sometimes  made  into  a  paste, 
under  the  name  of  Vienna  Paste^  which  is  milder  and  less  del- 
iquescent. 

Therapeutic  Uses. — Caustic  potassa  is  chiefly  employed  to  open 
abscesses,  and  in  the  treatment  of  chancres,  hospital  gangrene, 
eczema,  malignant  growths,  to  arrest  the  sloughing  of  carbuncles; 
in  tetanus,  applied  to  the  spine  ;  bites  of  rabid  animals  and  venom- 
ous reptiles ;  phlegmons  and  incipient  carbuncles,  to  arrest  their 
progress  ;  to  form  issues,  etc.  To  prevent  its  coming  in  contact 
with  neighboring  parts,  a  piece  of  adhesive  plaster  is  used,  with 
an  opening  corresponding  in  size  to  the  surface  on  which  the 
caustic  is  to  act.  When  mixed  with  water,  in  the  proportion 
of  caustic  potash,  o'ss  to  water,  f.^ij,  it  forms  a  rubefacient 
solution. 

Dental  Uses. — In  dental  practice,  caustic  potassa  is  employed 
in  gangrene  of  the  mouth  (cancrum  oris),  malignant  growths, 
fungous  growths  of  gum,  ulcers,  etc. ;  for  opening  abscesses, 
when  it  is  not  prudent  to  use  the  lancet. 


520  DENTAL  MEDICINE. 


POTASSIUM  BICARBONAS— BICARBONATE  OF  POTASSIUM. 

Formula.— KHCO^. 

Derivation. —  Bicarbonate  of  potassium  is  obtained  by  passing 
carbonic  acid  through  an  aqueous  solution  of  carbonate  of  potas- 
sium, until  it  is  completely  saturated.  The  solution  is  then 
filtered  and  evaporated,  the  product  being  bicarbonate  of  potas- 
sium, in  the  form  of  transparent,  colorless  crystals,  of  the  shape 
of  irregular  eight-sided  prisms.  It  is  inodorous,  with  a  saline 
and  somewhat  alkaline  taste,  and  is  soluble  in  water,  but  in- 
soluble in  alcohol.  Its  incompatibles  are  acids  and  acidulous 
salts,  etc. 

Medical  Properties  and  Action. — Bicarbonate  of  potassium  is 
antacid,  diuretic  and  antilithic.  In  large  quantities  it  is  a  cor- 
rosive poison. 

Therapeutic  Uses. — It  is  employed  internally  in  acute  rheuma- 
tism, gout,  and  uric  acid  lithiasis,  diseases  of  the  skin,  calculous 
affections,  etc.,  etc. 

Dose. — Of  bicarbonate  of  potassium,  gr.  v  to  3j. 

Dental  Uses. — Bicarbonate  of  potassium  is  employed  in  dental 
practice  as  an  antacid,  a  solution  being  serviceable  as  a  mouth 
wash,  to  prevent  injury  to"  the  teeth  from  acid  medicines. 

DENTAL    FORMULAE. 

/■"or  A^euralgia.  For  Facial  A^euralgia, 

J.  E.  GARRF.TSON.  ^^^^ 

R .        Ferri  sulphatis  exsic, 

„..,..    —  ,  R.        Potassii  bicarb.      .   tss 

rotassn  carbonatis  aa  gr.ccl  ^ 

c  •  nr  Ext.  ergotae  fluidi    f^j 

Syrup  acaciae    .    .  q.s.  M.  *'  «'•' 

•n-.       1      M      , Infusi  ergotse    .    .f5vi.         M. 

Ft.  pil.     No.  lOO.  =•  £>   ■" 

SiGXA. — Begin  with  3  a  day  and  in-      Signa. — Two   tablespoonfuls    every  4 

crease  to  6;  take  several  hundred.  hours. 

POTASSIUM  AND  SODIUM— KALIUM-NATRIUM. 

A  compound  or  alloy  of  potassium  and  sodium — kalium-natrium^ 
in  the  form  of  a  soft,  almost  semi-fluid  mass  prepared  by  Dr.  Emil 
Schreier,  and  employed  for  the  treatment  of  putrescent  pulp- 
canals.  Dr.  Schreier  claims  that  when  these  two  alkali  metals 
are   inserted   into  the   pulp-canal   they  come   in   contact  with  a 


BROMIDE  OF  POTASSIUM.  521 

watery  liquid,  when  immediately  violent  reaction  takes  place,  the 
water  is  decomposed,  with  the  development  of  considerable  heat, 
by  the  production  of  potassium  and  sodium  hydroxide  and  hydro- 
gen. The  sodium  and  potassium  hydroxides  unite  with  the  fatty 
substances  to  form  soap,  which  accounts  for  the  characteristic 
odor.  The  compound,  which  is  contained  in  a  tube,  is  applied 
to  the  root-canal  as  follows  :  When  the  cork  stopper  is  removed 
a  paraffin  layer  covering  the  preparation  is  exposed.  A  barbed 
nerve-extractor  is  then  pushed  through  this  paraffin  layer  into 
the  preparation,  and  upon  gently  withdrawing  the  instrument 
small  particles  of  the  potassium  and  sodium  compound  adhere  to 
the  barbs  of  the  instrument,  in  which  condition  it  is  ready  for 
introduction  into  the  pulp-canal.  Dr.  Schreier  advises  care  as  to 
its  use,  especially  avoiding  an  excess  at  any  one  application ; 
otherwise  the  action  would  be  too  violent.  The  rubber-dam 
should  be  applied  in  all  cases.  Practical  tests  of  this  compound 
have  given  satisfactory  results. 

POTASS!  BROMIDUM— BROMIDE  OF  POTASSIUM. 

Formula. — KBr. 

Derivation. — Bromide  of  potassium  is  obtained  by  adding  a 
solution  of  pure  carbonate  of  potassium  to  a  solution  of  bromide 
of  iron.  The  iron  being  precipitated,  the  bromide  of  potassium 
is  obtained  from  the  solution  by  evaporation.  It  is  in  the  form 
of  white  crystals,  without  odor,  wholly  soluble  in  water,  and  but 
sparingly  soluble  in  alcohol,  and  having  a  pungent,  saline  taste. 

Medical  Properties  and  Action. — Bromide  of  potassium  is  stim- 
ulant, sedative,  narcotic  and  antispasmodic,  and,  being  absorbed 
into  the  system,  can  be  detected  in  the  blood,  urine,  faeces  and 
mucus.  If  administered  in  considerable  quantity,  the  action  of 
the  heart,  respiration,  and  the  temperature  are  depressed,  and 
although  in  some  cases  a  transient  excitement  may  be  caused  by 
large  doses,  the  effect  of  this  agent  is  to  induce  a  sound  and  re- 
freshing sleep,  and  if  its  use  is  long  continued,  a  constant  drowsi- 
ness is  experienced.  Bromide  of  potassium  has  also  the  power 
of  lessening  the  sensibility  to  pain,  especially  causing  a  loss  of 
sensibility   of  touch   in  the   case  of  the   mucous  membrane  and 


522  DENTAL  MEDICINE. 


skin,  which  is  due  to  the  local  action  of  the  salt  as  it  is  elimi- 
nated. The  long-continued  use  of  this  agent  also  causes  a  loss 
of  motion,  and  if  it  is  injected  into  the  tissues  of  a  limb,  it  will 
cause  paralysis  of  motion  and  sensibility.  It  also  diminishes  the 
sexual  feeling,  and  the  condition  which  a  long  course  of  the  bro- 
mides develop  is  known  as  bromism^  which  is  characterized  by 
weakness  of  mind,  confusion,  headache,  pallor,  and  anaemia,  un- 
certain gait,  etc. 

Therapeutic  Uses. — Bromide  of  potassium  is  employed  as  an 
internal  remedy  in  cerebral  affections,  acute  rheumatism,  cholera 
infantum,  seasickness,  vomiting  of  pregnancy,  affections  of  the 
heart,  as  shown  by  increased  action,  neuralgia,  maniacal  excite- 
ment, tetanus,  strychnia  poisoning,  epilepsy,  spasmodic  asthma, 
spasmodic  cough,  etc.,  etc. 

Dose. — Of  bromide  of  potassium,  gr.  v  to  .5j. 

Dental  Uses. — Bromide  of  potassium  is  a  useful  remedy  in  in- 
fantile convulsions  from  the  irritation  of  dentition,  and  is  also 
efficacious  in  preventing  such  conditions  by  relieving  the  irrita- 
tion ;  also  in  neuralgia,  due  to  diseased  teeth,  and  in  facial  neu- 
ralgia when  congestive  in  character.  When  combined  with 
morphine,  bromide  of  potassium  is  useful  for  neuralgia  of  the 
fifth  nerve  in  the  adult. 

As  its  local  effect  is  to  diminish  sensibility,  it  has  been  applied 
to  the  pharynx  and  velum  palati,  in  order  to  prepare  such  parts 
for  the  taking  of  impressions  for  artificial  palates,  and  to  over- 
come extreme  susceptibility  of  the  mucous  membrane  of  the  roof 
of  the  mouth  in  first  wearing  artificial  dentures.  For  such  pur- 
poses the  agent  is  administered  in  one-half  drachm  doses  3  times 
daily  for  two  or  three  weeks  previously ;  or  doses  of  grs.  xx  to 
xxx  may  be  given,  repeated  two  or  three  times. 


DENTAL    FORMULA. 

jFor  Infantile  Diarrhcca  from  Reflex  Nervous  Impressions. 

R.         Potassi  bromidi gr.xviij  to  ^ss 

Potassi  nitratus gr.vj 

Sacchari  lactis ^ss.  M. 

Ft.  pulv.  vj. 
SiGNA. — One  powder  every  3  or  4  hours  to  a  child  i  year  of  age. 


CHLORATE  OF  POTASSIUM.  523 

POTASSII  CHLORAS— CHLORATE  OF  POTASSIUM. 

Formula.— KCIO^. 

Derivation. — Chlorate  of  potassium  is  obtained  by  passing  an 
excess  of  chlorine  through  a  solution  of  carbonate  of  potassa  and 
slaked  lime;  the  chlorine  being  converted  into  chloric  acid  by 
the  hydrogen  of  the  lime  and  the  acid  combining  with  the 
potassa,  forming  chlorate  of  potassium.  It  is  in  the  form  of 
colorless  or  white  crystals,  of  a  pearly  lustre,  altogether  soluble  in 
distilled  water,  and  in  twelve  parts  of  cold  and  two  parts  of  boil- 
ing water.  It  is  inodorous,  with  a  cool,  saline  taste,  and  when 
applied  to  animal  fluids  does  not  decompose  them  nor  undergo 
any  change,  although  perfectly  soluble  in  such  fluids.  It  is  ab- 
sorbed by  the  blood,  and  is  eliminated  by  the  kidneys. 

Medical  Properties  and  Action. — Chlorate  of  Potassium  is 
detergent,  refrigerant,  diuretic  and  stimulant,  and  its  action  as  a 
refrigerant  and  diuretic  is  similar  to  that  of  nitrate  of  potassa. 
It  improves  the  appetite,  and  on  account  of  the  large  quantity  of 
oxygen  it  contains,  has  been  employed  in  contaminated  condi- 
tions of  the  blood  as  an  oxidizing  agent.  Although  it  may  be 
administered  with  impunity  in  very  large  doses,  yet  excessive 
quantities  have  given  rise  to  gastro-enteric  inflammation,  with 
fatal  effects. 

Therapeutic  Uses. —  Chlorate  of  Potassium  is  employed  in  con- 
tinued and  typhoid  fevers,  neuralgia,  croup,  diphtheria,  sore  throat, 
chronic  bronchitis,  phthisis,  scrofula,  erysipelas,  scurvy,  mercu- 
rial salivation,  etc.,  etc.  Externally,  it  is  employed  in  the  treat- 
ment of  ozaena,  sore  throat  of  scarlatina,  pharyngitis,  cancerous 
sores,  ulcerated  surfaces,  fetid  and  scrofulous  ulcers,  etc.,  etc. 
Poisonous  symptoms  have  resulted  from  the  habitual  use  of  chlorate 
of  potassium,  and  several  cases  of  death  have  been  recorded. 

Dose. — Of  chlorate  of  potassium,  gr.  v  to  9j,  every  three  or 
four  hours ;  for  children,  gr.  iij  in  sweetened  water  every  four 
hours  for  a  child  three  years  of  age ;  gr.  v  for  one  of  eight  or 
nine  years,  with  due  attention  to  the  bowels  and  constitution, 
regulating  the  former  and  supporting  the  latter.  In  the  case  of 
teething  children,  gr.  ij  may  be  administered  to  a  child  of  one 
year  of  age. 


524 


DENTAL  MEDICINE. 


Troches  of  Chlorate  of  Potassium  are  prepared  by  a  combination 
of  chlorate  of  potassium,  Sv  ;  sugar,  Sxviij  j  tragacanth,  5ij  ; 
vanilla,  gr.  xxx ;  mixed  together  with  water  into  a  mass  and 
divided  into  480  troches,  each  of  which  contains  gr.  v  of  chlorate 
of  potassium  ;  useful  for  sore  throat,  etc. 

Dental  Uses. — Chlorate  of  potassium  is  a  valuable  agent  in  dental 
practice  as  an  internal  and  external  resolvent  and  detergent  remedy  in 
the  various  forms  of  stomatitis — inflammation  of  the  gums,  aphthae 
and  other  ulcerative  affections,  gangrenous  stomatitis,  mercurial 
stomatitis,  erysipelatous  inflammation  of  the  mouth,  scurvy,  ulcers 
of  the  gums,  cheeks  and  tongue,  abraded  surfaces  of  mucous  mem- 
brane, secondary  syphilitic  ulcerations  of  the  mouth,  indolent  and 
scrofulous  ulcers,  etc.,  for  such  purposes  being  used  alone  in  the 
form  of  mouth  washes  or  gargles,  or  in  combination  with  tannic 
acid,  alum,  borax,  glycerine,  etc.  In  the  treatment  of  mercurial 
stomatitis,  great  benefit  is  derived  from  both  its  internal  and  ex- 
ternal use.  For  the  inflamed  gums  of  teething  children  it  is  em- 
ployed as  a  lotion,  with  beneficial  effects.  In  the  form  of 
powder  it  is  a  useful  application  to  ulcerated  and  abraded  sur- 
faces. A  simple  gargle  or  mouth  wash  may  be  made  by  dissolv- 
ing one  drachm  of  chlorate  of  potassium  in  four  ounces  of  water, 
or  half  an  ounce  may  be  dissolved  in  a  pint  of  water. 

DENTAL    FORMULA. 


For  Inflamed  Gums  after  the  Extrac- 
tion of  Teeth. 

R .    Potassii  chloratis    .    .     3  ij 
Tincture  kramerise, 
Glycerini     .    .    .    .{laf,^ss 
Aquae  Rosae ^^'U-    ^• 

SiGNA. — To  be  used  as  a  gargle  6  or  8 
times  daily,  to  harden  the  gums. 

For  Ulcers  and  Suppurating  Wounds. 

U.    Potassii  chloratis    .    .     3J 

Glycerini ^iss.     M. 

SiGNA. — To  be  used  as  a  lotion.  , 


For  Aphthous  and  Secondary  Syphi- 
litic Ulceration  of  the  Mouth  and 
Fauces. 

B .    Potassii  chloratis    .    .     3  iv 

Aquse  destillatse  ...     ^x.       M. 
SiGNA. — To    be  used  as   an  antiseptic 
mouth  wash. 


R. 


For  Ulceration  of  the  Mouth. 

Bartholow. 
Potassii  chloratis 
Acidi  carbolici    . 
Aquae  destillatae  ...     .^  iv.      M. 


3J 

SiGNA. — To  be  used  as  a  lotion. 


NITRATE  OF  POTASSIUM. 


525 


For  Ulceration    and  Injiamination  of 
the  Gums  and  AIucous  Membrane. 


Stocken. 

Potassii  chloratis    . 

•    3U 

Sodii  biboratis    .    . 

■    3J 

Potassii  nitratis  .    .    , 

•    3SS 

Aquae  destillatce  .   .    , 

■     .?  viij, 

M. 
SiGNA. — To  be  used  as  a  gargle. 

For  Inflammation  of  Gums  and  Mu- 
cous Membrane, 


Stock  EN. 

Ij(.    Potassii  chloratis 

■    3U 

Sodii  biboratis    .    . 

•    3J 

Potassii  nitratis  .    . 

•    3SS 

Tinct.  Arnicse  .  .    . 

•    3'J 

Aquae  Rosae .... 

•     5^'J 

SiGNA. — To  be  used  as  a 

gargle. 

M. 


For   Inflamed   Gums,   Mucous   Mem- 
brane, etc. 
R,    Potassii  chloratis  .  .    .     gj 
Sodii  biboratis    ...     gjj 
Aquae  destillatae  ...     ^  ij.       ^L 
SiGN.\. — To  be  used  as  a  mouth  wash 
or  gargle. 


For  Inflamed  Gums  and  Mouth. 
R .    Potassii  chloratis    .    .     J5  ij 
Pulv.  aluminis    ...     3  ij 
Aquae  destillatas  ...     ^  x.        M. 
SiGNA. — To  be  used  as  a  gargle. 

For  Inflamed  Mucous  Membrane. 
R .    Potassii  chloratis    .    .     ^j 
Aluminje  sulph.  .    .    .     gj 
Aquae  destillatas  ...     ^  iv.      M. 
SiGNA. — To   be   applied  as   a   mouth 
wash. 

F'or  Periodontitis. 

R.  Potassii  chloratis.  .  .  ^j 
Plunibi  acetas  .  .  .  ^j 
Aquffi  font ^ij.       M. 

SiGNA. — To  be  used  as  a  mouth  wash. 

For  Ulceration  of  Gums  aad  Mucous 

Membrane  of  Moutk. 
R .    Potassii  chloratis  ...     5  ij 

Aquae ^  v.       M. 

SiGNA. — A  tablespoonful  three  times  a 
day;  also  as  a  gargle  four  or  five 
times  a  day. 


POTASSI  NITRAS— NITRATE  OF  POTASSIUM. 
SALTPETRE NITRE. 

Formula. — KNO3. 

Derivation. — Nitrate  of  Potassium  is  obtained  in  the  native 
state  in  various  portions  of  the  world  ;  but  the  variety  employed 
for  medicinal  purposes  is  prepared  by  purifying  the  native  pro- 
duction of  India.  It  can  also  be  artificially  made  by  combining 
decayed  organic  animal  and  vegetable  matters,  or  by  the  double 
decomposition  of  nitrate  of  sodium  and  chlorate  of  potassium. 
The  crude  nitre  is  refined  by  re-solution  and  crystallization.  It 
is  in  the  form  of  white,  crystalline,  six-sided  prisms,  odorless, 
v/ith  a  sharp,  saline,  cooling  and  slightly  bitter  taste,  wholly  solu- 
ble in  water,  but  insoluble  in  alcohol. 

Medical  Properties  and  Action. — Nitrate  of  potassium  is  refrig- 
erant, sedative,  antiseptic,  diuretic  and  diaphoretic.  It  promotes 
the  secretions,  lessens  the  heat  of  the  body  and  the  frequency  of 


526  DENTAL  MEDICINE. 


the  pulse.  For  allaying  febrile  excitement  it  is  frequently  em- 
ployed in  the  form  of  nitrous  powders  (nitre^gr.  x ;  tartar  emetic, 
gr.  \ ;  calomel,  gr.  \  to  \). 

In  overdoses,  nitrate  of  potassium  causes  pain  and  heat  in  the 
stomach,  vomiting  and  purging  of  blood,  inflammation  of  the 
bowels,  great  prostration,  convulsions,  and  sometimes  death. 

The  antidotes  are  emetics,  mucilaginous  and  demulcent  drinks, 
and  stimulants  to  sustain  the  sinking  powers  of  the  system. 

Therapeutic  Uses. — Nitrate  of  potassium  is  employed  internally 
as  a  refrigerant  in  febrile  affections,  in  inflammatory  diseases, 
acute  rheumatism,  scurvy,  purpura,  haemoptysis,  passive  hemor- 
rhages, asthma,  etc.  In  fevers  it  is  frequently  combined  with 
other  remedies.     The  vapor  is  used  in  spasmodic  asthma. 

Dose. — Of  nitrate  of  potassium,  gr.  ij  to  gr.  x. 

Dental  Uses. — In  dental  practice,  nitrate  of  potassium  has  been 
recommended  in  the  incipient  stages  of  alveolar  abscess,  being 
introduced  into  the  pulp  canal  and  secured  by  a  temporary  filling 
in  the  crown  cavity  of  the  tooth.  It  is  also  employed  in  inflam- 
matory conditions  of  the  mucous  membrane  of  the  mouth  and 
throat  in  the  form  of  gargles. 

DENTAL  FORMULiE. 

J^or  Inflammation  of  the  Mouth  and       ^^^  Inflamed  Mucous  Membrane  and 
Throat.  <^«'«^- 

T.  W.  White.  K-    Potassii  nitratis  .    .    .     ^ss 

R.    Potassii  nitratis  .    .    .     3J  to  gij  Potassii  chloratis    .    .     ^ij 

AquEe  destillatse  ...    Oj.         M.  Sodii  biboratis    .    .    .     3J 

SiGNA.— To  be  used  as  a  gargle.  Aquse  destillata  .    .    .     ^  viij.    M. 

SiGNA. — To  be  used  as  an  antiseptic 
and  refrigerant  mouth  wash. 

POTASSII  PERMANGANAS— PERMANGANATE  OF  POTASSIUM. 

Formula. — KgM  ngOg. 

Derivation. — Permanganate  of  potassium  is  obtained  by  the 
mixture  of  equal  parts  of  black  oxide  of  manganese  and  chlorate 
of  potassium,  with  a  slight  excess  of  caustic  potassa,  dissolving 
in  water,  and  evaporating  to  dryness,  when  it  is  exposed  to  a 
nearly  red  heat;  the  chlorate  of  potassium  yields  oxygen,  which 
changes  the  black  oxide  of  manganese  into  permanganic  acid,  and 


PERMANGANATE  OF  POTASSIUM.  597 

this  acid,  combining  with  the  potassa,  gives  as  a  product  the  per- 
manganate of  potassium.  It  is  in  the  form  of  dark  purple, 
slender,  prismatic  crystals,  inodorous,  very  soluble  in  water, 
forming  a  solution  of  a  beautiful  lilac  color,  even  in  very  minute 
proportion,  and  with  a  sweet,  astringent  taste. 

Medical  Properties  and  Action. — Permanganate  of  potassium 
when  taken  internally,  is  supposed  to  oxydize  the  blood.  It  is 
a  stimulant,  mild  escharotit,  and  is  a  powerful  disinfectant,  as  it 
has  a  remarkable  power  of  destroying  fetid  odors  from  organic 
sources,  and  proves  useful  in  preventing  the  spread  of  infectious 
disease.  It  yields  up  its  oxygen  readily,  in  the  form  of  ozone, 
and  its  use  depends  upon  this  property.  It  is  instantly  decom- 
posed on  reaching  the  stomach. 

Therapeutic  Uses. — Permanganate  of  potassium  is  employed 
with  advantage  in  dyspepsia,  flatulence,  excessive  deposition  of 
fat,  uric  acid  diathesis,  acute  rheumatism,  diabetes,  scarlatina, 
petechial  fever,  spinal  meningitis.  Condy's  Fluid  is  a  favorite 
preparation  with  some,  for  both  internal  and  external  use.  The 
most  important  uses  for  permanganate  of  potassium  are  exter- 
nally, as  a  deodorizer  and  disinfectant,  to  correct  the  fetor  of 
cancer,  abscesses,  ulcers,  caries  of  bone,  ozasna,  otorrhcea, 
gonorrhoea,  leucorrhoea,  ulcerated  sore  throat,  etc.,  in  the  form 
of  injections,  lotions  and  spray.  It  is  also  used  externally  in  the 
treatment  of  diphtheria,  in  the  proportion  of  a  drachm  of  Condy's 
Fluid  to  the  ounce  of  water.  In  solution,  permanganate  of 
potassium  is  applied  in  varying  strength,  according  to  the  effect 
desired.  As  a  local  stimulant,  as  well  as  deodorizer,  it  is  useful 
in  chronic  and  indolent  ulcers,  carbuncles,  hospital  gangrene,  etc. 
The  powder  may  be  sprinkled  on  gangrenous  surfaces.  In 
concentrated  solution  permanganate  of  potassium  acts  as  a 
caustic.  A  strong  solution  is  composed  of  10  parts  dissolved  in 
90  parts  of  water,  and  is  employed  in  its  full  strength  in  can- 
cerous, phagedenic  and  atonic  ulcers.  For  dressing  simple 
wounds,  or  as  an  injection  in  abscesses,  ozasna,  leucorrhcea,  etc., 
half  a  fluid  ounce  of  the  solution  may  be  added  to  a  pint  of 
water ;  in  gangrenous  and  diphtheritic  wounds  and  scrofulous 
ulcers,  a  fluid  ounce  of  the  solution  to  a  pint  of  water. 


528  DENTAL  MEDICINE. 


Dose. — Of  permanganate  of  potassium  for  internal  use,  gr.  ^^ 
to  gr.  j,  three  times  a  day.  Candy's  Fluid  is  composed  of  32 
grains  of  permanganate  of  potassium  in  one  pint  of  distilled 
water ;  half-fluid  ounce  contains  one  grain.  Dose  of  Candy's 
Fluid^  ITLv.  For  external  application,  foj,  to  water,  fgv  to  x. 
Solution  of  permanganate  of  potassium — Liquor  Potassii  Perman- 
ganatis^  is  composed  of  64  grains  of  permanganate  of  potassium 
to  one  pint  of  distilled  water.  M.de  Lacerda  has  recently  dis- 
covered that  permanganate  of  potassium  is  one  of  the  most 
energetic  antidotes  to  the  venom  of  snakes. 

Dental  Uses. — In  dental  practice  the  permanganate  of  po- 
tassium is  employed  in  the  treatment  of  fetid  and  gangrenous 
ulcerations  of  the  mouth,  such  as  cancrum  oris,  foul  abscesses, 
ulcerations  of  mucous  membrane  attended  with  fetid  discharges, 
offensive  breath ;  as  an  antiseptic  in  decomposing  pulps  of 
teeth  (grs.  ij  to  water  5j);  in  diseases  of  the  antrum,  such  as 
abscess,  and  caries  and  necrosis  of  the  maxillary  bones,  Riggs' 
disease,  ulcers  of  the  mouth,  pyorrhcea  alveolaris,  etc.  (grs.  x 
to  water  5j).  The  powdered  crystals  introduced  into  a  carious 
cavity  will  relieve  odontalgia.  The  stains  of  permanganate  of 
potassium  can  be  removed  by  dilute  hydrochloric  acid. 

DENTAL    FORMULAE. 

For   Unhealthy    Ulcers  of  the  Mouth,      For    Fetid    Perspiration     and    Foul 
and  Offensive  Breath.  Breath. 

J.W.White.  g^_    Potassii  permanganatis  .   gr.j 

R .    Potas.  permanganatis  ^j  to  iv  Aquae  destillatse  .    .    .    .  f  §  i.    M. 

Aquae  destillatae  .    .     Oj.  M.      SiGNA. — To  be  used  as  a  lotion  and 

SiGNA. — To  be  used  as  a  gargle.  gargle. 

For    Gangrenous    Ulceration    of  the      For  a  Disinfectant  in  Mercurial  Sali- 

Mouth — Cancrum  Oris.  vation. 

R .    Potassii  permanganatis  gr.xxx  R .    Potassii  permanganatis  gr.  xv 

Aquae  destillatse  .    .    .  ^j.  M.  Aquae  destiliatse  .    .    .  f^viij.  M. 

SiGNA. — Apply  as  a  lotion.  Signa. — Use  as  a  gargle. 

For  Ulcers,  Abscesses,  Decomposing  Pulps  of  Teeth,  etc. 

R .    Liquoris  potassii  permanganatis :^j 

Aquae  destillatae 3  vj  to  x.  M. 

SiGXA. — To  be  used  as  a  gargle  or  as  an  injection. 


PYOCTANINE.  529 


PVOCTANIN— METHYL-VIOLET— PYOCTANINE. 

Derivation. — Pyoctanine  is  only  a  name  applied  to  the  well- 
known  aniline  color  methyl-violet,  an  aniline  dye,  which  is  in 
the  form  of  a  paste  and  in  crystals. 

It  is  without  color,  but  slightly  irritant,  and  non-intoxicating. 
It  has  been  employed  in  the  form  of  powder,  solution  and  pencil. 
The  powder  is  made  by  mixing  2  parts  of  pyoctanine  or  methyl- 
violet  with  100  parts  of  talc  or  other  inert  substance.  The 
solution  is  of  any  strength  from  i  part  in  100  to  i  in  2000. 
Pyoctanine  is  also  used  in  the  form  of  ointment  containing  from 
2  to  10  per  cent.  There  is  also  another  aniline  color — the 
yellow — to  which  the  same  name  has  been  given  ;  but  the  violet 
is  the  stronger. 

Medical  Properties  and  Therapeutic  Uses. — Pyoctanine  is  con- 
sidered by  many  to  be  an  efficient  germicide.  According  to 
Fessler,  the  micro-organisms  of  pus  are  destroyed  by  it  in  fifteen 
minutes  when  the  solution  is  of  the  strength  of  i  to  1000.  This 
action  is,  however,  denied  by  Troje,  who  considers  pyoctanine 
to  be  less  powerful  than  bichloride  of  mercury,  or  even  carbolic 
acid.  It  does  not  coagulate  albumen,  and  when  applied  to  the 
eye  causes  dilatation  of  the  pupil  without  paralysis  of  accommo- 
dation. Pyoctanine  is  emploved  topically  to  disinfect  suppura- 
ting or  ulcerated  wounds,  to  stimulate  chronic  ulcers.  As  an 
application  to  open  buboes,  boils,  carbuncles,  chancroids,  etc. ; 
also,  in  the  form  of  weak  solution,  in  gonorrhoea,  and  chronic 
cystitis.  And  as  a  dusting  powder  in  moist  eczema,  and  also  in 
other  affections  of  the  eve,  the  ear,  nose  and  throat. 

It  has  no  odor  and  in  this  respect  is  preferable  to  iodoform,  but 
it  stains  the  skin ;  the  discoloration  may  be  removed  by  cologne 
water,  alcohol,  dilute  hydrochloric  or  nitric  acids. 

Dental  Uses. — Pyoctanine  is  employed  in  dental  practice  in  all 
cases  where  ordinary  antiseptics  are  indicated,  as  in  gangrenous 
pulps,  root-canals,  disinfecting  cavities  before  filling,  alveolar 
abscess,  etc. 

PYRETHRUM— PELLITORY. 

Source. — Pyrethrum  is  a  native  of  the  Mediterranean  coast,  and 
34 


530  DENTAL  MEDICINE. 


the  root  is  the  medicinal  portion — pyrethri  radix^  in  the  form  of 
cylindrical,  wrinkled  pieces,  of  the  size  of  the  little  finger,  hard 
and  brittle,  which,  when  dried,  have  little  or  no  odor.  Exter- 
nally, it  is  of  an  ash-brown  color,  within  white,  and  possesses  an 
extremely  acrid  taste,  with  a  burning  and  tingling  sensation  over 
the  whole  mouth  and  throat,  which  continues  for  some  time,  and 
excites  a  copious  flow  of  saliva. 

Medical  Properties  and  Action. — Pyrethrum  root  is  an  irritant 
and  sialogogue,  and  when  it  is  rubbed  on  the  skin  it  causes  much 
irritation,  and  may  even  excite  inflammation. 

Its  activity  depends  upon  an  acrid  oil  and  a  compound  resin 
called  pyrethrin.  It  is  rarely  used  internally,  and  only  as  a 
masticatory. 

Therapeutic  Uses. — Pyrethrum  has  been  employed  as  an  exci- 
tant in  paralysis  of  the  tongue  and  muscles  of  the  throat,  relaxed 
sore  throat,  spontaneous  salivation,  certain  forms  of  headache  -, 
for  such  purposes  being  chewed,  or  employed  in  the  form  of  a 
gargle,  in  tincture  or  decoction. 

Dose. — Of  pyrethrum  as  a  masticatory,  gr.  xv  to  5j-  Tinctura 
Pyrethri^  Tincture  Pyrethrum,  is  composed  of  pyrethrum  Siv, 
rectified  spirit  Oj. 

Dental  Uses. — Pyrethrum  has  been  employed  in  dental  practice 
for  neuralgic  affections  of  the  face,  for  which  it  is  chewed ;  for 
the  relief  of  odontalgia,  in  the  form  of  the  tincture  applied  to 
the  irritable  pulp  on  a  pellet  of  cotton ;  as  a  stimulant  to  the 
gums  and  mucous  membrane  of  the  mouth  in  relaxed  conditions ; 
for  obtunding  sensitive  dentine,  in  the  form  of  a  strong  alcoholic 
extract.  The  ethereal  oil  of  pyrethrum  is  recommended  as  a 
pleasant  and  efficacious  remedy  in  odontalgia,  applied  in  the  same 
manner  as  the  tincture ;  the  fluid  extract  is  also  employed  as  an 
ingredient  for  local  anaesthetic  preparations,  combined  with  chloro- 
form, ether  and  lavender,  etc.     (See  Chloroform.) 

DENTAL      FORMULA. 
For  Relaxed  Conditions  of  Mucous  Alembrane  of  Mouth  and  Gums. 

R .         Tinctura  pyrethri f 3  "J 

Aquae Sviij.      M. 

SiGNA. — To  be  used  as  a  stimulant  gargle. 


PYROZONE.  531 


PYROZONE. 

Formula. — HjOg. 

Derivation. — Pyrozone  has  the  same  formula  as  peroxide  of 
hydrogen,  and  is  presented  in  the  form  of  solution  only.  Various 
percentages  have  been  produced  which  are  devoid  of  poisonous 
properties  and  other  objectionable  features.  It  is  presented  in 
the  following  percentages  :  An  aqueous  medicinal  solution  of 
pyrozone,  3  per  cent. ;  an  ethereal  solution  which  is  antiseptic, 
8  per  cent.,  and  a  caustic  ethereal  solution  of  25  per  cent., — all 
of  the  same  formula  H2O2. 

Medical  Properties  and  Action. — The  medicinal  3  per  cent, 
aqueous  solution  acts  with  great  rapidity,  causing  instant  effer- 
vescence, and  is  a  harmless  antiseptic  externally  or  internally.  It 
is  nearly  neutral,  and  its  cleansing  effects  in  removing  mucus  are 
very  effective.  The  ethereal  5  per  cent,  solution  is  powerfully 
antiseptic,  and  acts  on  pus  with  remarkable  energy. 

The  caustic  25  per  cent,  solution,  also  ethereal,  is  the  most 
powerful,  and  both  it  and  the  5  per  cent,  solution,  when  applied 
to  the  skin,  cause  a  tingling  sensation  and  a  marble  whiteness, 
similar  in  appearance  to  that  caused  by  carbolic  acid  ;  the  dis- 
coloration of  the  pyrozone,  however,  disappears  after  some  hours 
without  leaving  any  marks  or  other  bad  effects. 

The  25  per  cent,  solution  is  not  only  a  powerful  caustic,  but 
is  also  considered  to  be  a  very  safe  one,  as  the  rapid  evaporation 
of  its  solvent — ether — leaves  the  concentrated  HjOg  behind. 
When  not  in  use  these  solutions  should  be  kept  from  contact 
with  organic  matters,  on  account  of  their  rapid  action.  All  of 
the  pyrozone  solutions  are  prompt  hemostatics  ;  but  the  3  per 
cent,  solution  is  the  best  for  such  a  purpose,  for  the  reason  that 
its  caustic  action  is  less  than  that  of  the  5  per  cent,  or  25  per 
cent,  solutions. 

All  of  the  pyrozone  solutions  are  bleachers,  but  the  5  per  cent, 
and  25  per  cent,  solutions  act  more  promptly  for  such  a  purpose, 
on  account  of  the  action  of  the  hydrogen  on  organic  coloring 
matter,  and  not  by  reaction  due  to  acid.  The  painful  sensation 
produced  by  the  stronger  solutions  coming  in  contact  with  a 
healthy  surface  may  be  quickly  relieved  by  rubbing  freely  with 


532  DENTAL  MEDICINE. 


tannin  and  glycerine ;  and  if  gloves  are  worn  on  the  hands  placed 
in  pockets,  any  stains  on  the  fingers  will  disappear  within  one 
hour,  and  no  sloughing  or  soreness  result.  Care  should  be  exer- 
cised as  to  the  quantity  of  the  pyrozone  solution  employed ; 
hence  cotton,  or  silk  ropes,  or  tampons  should  not  be  so  saturated 
as  to  permit  an  excess  to  be  forced  out  and  come  in  contact  with 
healthy  tissues  or  surfaces  when  the  pyrozone  is  employed  in  a 
pocket  or  fistula.  The  3  per  cent,  medicinal  solution  is  put  up 
in  4  ounce  glass-stoppered  bottles,  and  the  5  per  cent,  and  25  per 
cent,  solutions  in  sealed  glass  tubes,  the  contents  of  which  can  be 
transferred  to  clean  glass  bottles  with  ground  stoppers,  not  filled 
too  full,  and  kept  in  an  upright  position. 

Therapeutic  Uses. — The  3  per  cent,  solution  of  pyrozone, 
being  free  from  odor  and  toxic  properties,  may  be  used  with  ad- 
vantage when  carbolic  acid  or  other  disinfectant  is  indicated.  In 
certain  forms  of  indigestion  or  dyspepsia,  ulcers  of  the  stomach, 
and  gastritis,  the  3  per  cent,  solution  may  be  given  internally  in 
doses  of  5j  three  times  a  day  before  meals.  In  long-standing 
epilepsy.  Dr.  B.  W.  Richardson  has  administered  it  in  5ij  doses 
twice  daily.  Externally,  the  5  per  cent,  and  25  per  cent,  solutions 
have  been  employed  in  rhinitis,  ulcerations,  diphtheria,  syphilitic 
ulcerations,  old  sinuses,  fistulous  tracts  from  bone  disease,  lupus 
erythematous,  alopecia  areata,  ringworm,  nasal  diseases,  etc.,  etc. 

Dental  Uses. — The  3  per  cent,  aqueous  solution  may  be  used 
freely  as  a  mouth  wash,  also  as  a  gargle,  but  considerable  irrita- 
tion follows  its  contact  with  the  throat.  Used  as  a  mouth  wash 
it  will  remove  the  oily  deposit  and  absorbent  coating  on  the  teeth 
of  smokers  ;  also  as  an  irrigating  and  detergent  wash  in  abscesses, 
sinuses  and  ulcerations.  The  3  per  cent,  aqueous  solution  is  also 
recommended  by  Dr.  C.  B.  Atkinson  as  a  valuable  adjunct  in 
caring  for  a  frequent  condition  of  children's  mouths,  where, 
from  malnutrition  during  gestation  and  the  sundry  eczemas  of 
childhood,  the  teeth  become  pitted  or  wasted  of  the  enamel,  by 
which  cavities  are  exposed  to  the  destructive  influence  of  caries, 
as  the  3  per  cent,  solution  both  bleaches  teeth  in  this  condition 
and  retards  the  progress  of  destruction. 

The  3  per  cent,  solution  is  also  effective  as  a  wash  or  injection 


PYROZONE.  533 


into  large  abscess  pockets  as  an  excellent  cleanser  and  means  of 
cure.  As  a  bleaching  agent  the  3  per  cent,  solution,  however, 
is  less  penetrating  in  its  effects  than  either  the  5  per  cent,  or  25 
per  cent,  solutions ;  and  used  as  a  spray  it  will  by  its  oxydizing 
effect  bring  to  the  surface  from  between  the  teeth  any  pus  pres- 
ent. It  will  also  act  upon  any  incrustations  about  the  teeth, 
softening  them  and  rendering  their  removal  easy. 

The  5  per  cent,  ethereal  solution  is  employed  in  abscess 
pockets,  fistula  or  sinuses,  fistulous  roots,  alveolar  pyorrhoea,  small 
quantities  only  being  used  at  a  time.  The  solution  may  be 
dropped  from  an  ordinary  glass  stopper,  a  drop  at  a  time  until  the 
desired  effect  is  produced  ;  or  it  may  be  applied  on  a  tapered 
piece  of  orange  wood,  or  an  attenuated  glass  rod,  or  as  an  injec- 
tion with  a  syringe,  or  by  a  special  pyrozone  atomizer  in  the  form 
of  spray.  In  treating  fistulas  of  alveolar  abscesses,  the  solution 
may  be  introduced  on  cotton  or  other  tents,  so  that  it  may  be 
carried  well  within  the  tract. 

The  5  per  cent,  solution  is  also  an  efficient  bleacher  of  discol- 
ored teeth,  and  causes  no  injurious  action  on  the  tooth  structure, 
or  on  myxomatous  tissues;  and  its  application  to  ulcerating  sur- 
faces brings  about  a  rapid  reduction  of  the  suppuration  without  a 
resulting  coagulum. 

The  5  per  cent,  ethereal  solution  of  pyrozone  appears  to  be 
more  generally  serviceable,  but  if  the  ether  is  permitted  to  evap- 
orate it  may  become  caustic,  as  concentration  follows  evapora- 
tion. For  bleaching  discolored  teeth,  a  pledget  of  cotton 
saturated  with  the  solution  may  be  placed  in  the  cavity,  and  the 
surface  of  the  crown  of  the  tooth  be  wiped  over  with  the  same 
5  per  cent,  solution  ;  it  is  also  useful  in  removing  the  green  stain 
common  on  the  necks  of  children's  teeth,  but  care  must  be  taken 
that  the  solution  does  not  touch  the  gums.  Great  care  must  also 
be  taken  not  to  allow  the  stronger  pyrozone  solutions  to  come  in 
contact  with  an  exposed  pulp,  as  it  expands  such  a  tissue  very 
greatly,  and  as  a  consequence  causes  excruciating  pain. 

The  25  per  cent,  solution  of  pyrozone  is  caustic  in  its  action, 
and  its  use  in  preference  to  the  5  per  cent,  solution  will  depend 
upon  the  depth  or  rapidity  of  action  required,  as  the  5  per  cent. 


534  DENTAL  MEDICINE. 


solution  causes  less  pain,  and  may  answer  better  when  the 
mucous  membrane  is  very  irritable.  To  bleach  a  discolored 
tooth,  or  to  rapidly  cleanse  a  surface,  or  where  the  disease  is  diffi- 
cult to  reach  on  account  of  its  depth,  the  25  per  cent,  solution 
answers  better  than  the  5  per  cent,  solution,  on  account  of  its 
prompt  action.  The  antiseptic  and  caustic  solutions  of  pyrozone 
attack  the  hydrogen  in  the  color  compound  in  the  tubuli,  and 
when  this  is  given  off  only  water  remains.  For  bleaching  teeth 
the  rubber  dam  is  first  adjusted,  and  the  apical  foramen  of  the 
root  sealed  ;  then  by  means  of  a  glass  atomizer,  the  pyrozone  is 
sprayed  into  the  pulp-chamber  and  canal,  and  also  into  the  crown 
cavity.  The  effect  is  prompt  and  satisfactory.  The  solution 
may  also  be  applied  on  cotton  or  bibulous  paper,  but  no  metallic 
instruments  should  be  used  in  connection  with  the  agent ;  and  to 
renew  the  application  it  is  better  to  drop  the  pyrozone  on  the 
cotton  or  paper,  and  not  dip  again  into  the  bottle. 

Pyrozone  atomizers  are  constructed  with  three  tubes,  one  each 
for  the  upper  and  lower  teeth,  and  one  straight  tube  for  spraying 
other  parts.  For  treating  putrescent  pulps  and  alveolar  abscesses, 
the  dam  is  adjusted,  and  the  solution  of  pyrozone  carried  into  the 
root  and  apical  space  in  the  form  of  spray,  or  on  cotton  at  the 
end  of  a  wooden  probe  ;  the  pyrozone  being  applied  until  the  pus 
ceases  to  flow,  when  the  root  canal  is  filled  with  cotton,  which  is 
allowed  to  remain  until  the  following  day,  when  the  filling  may 
be  inserted,  or,  if  necessary,  a  second  application  of  pyrozone 
made,  which,  however,  is  seldom,  if  ever,  required.  The  con- 
tact of  the  antiseptic,  and  especially  of  the  caustic  solution  of 
pyrozone,  with  the  gum  or  skin,  causes  a  severe  burning  or 
pricking  sensation,  causing  a  white  stain,  more  of  the  nature  of  a 
bleached  spot  than  a  true  eschar,  which  may  be  prevented  by 
previously  painting  the  exposed  parts  with  glycerin.  The  pain 
may  be  relieved  by  the  application  of  glycerin,  or  glycerite  of 
tannin,  or  a  solution  of  bicarbonate  of  soda  (5ss  to  Sj).  For  the 
deep  pockets  of  alveolar  pyorrhoea,  a  small  tent  of  cotton  may  be 
saturated  with  the  25  per  cent,  solution,  and  its  application  will 
in  most  cases  terminate  the  suppuration.  (See  Suppurative 
Gingivitis.) 


WHITE  OAK.  535 


In  opening  glass  tubes  containing  pyrozone  by  filing  a  notch 
and  then  breaking  off  the  point,  care  must  be  taken  that  particles 
of  the  glass  do  not  enter  the  eye,  by  sudden  explosion,  and  de- 
stroy the  sight. 

QUERCUS  ALBA— WHITE  OAK. 

Source. — White  oak,  the  dried  inner  bark  of  which  is  the 
medicinal  portion,  is  a  common  tree  of  the  natural  order 
Amentacece.  The  bark  has  a  light-brown  color,  fibrous  texture 
and  an  astringent,  bitter  taste.  Its  medicinal  virtues  depend  upon 
the  presence  of  tannic  and  gallic  acids,  and  a  bitter  principle 
known  as  quercin.  Water  and  alcohol  form  with  it  decoctions 
and  tinctures. 

Medical  Properties  and  Action.  —  White  oak  bark  is  tonic, 
astringent  and  antiperiodic.  It  is  principally  used  as  an  external 
application. 

Therapeutic  Uses. — White  oak  bark  is  employed  internally  in 
the  treatment  of  diarrhoea,  dysentery  and  hemorrhoids.  Ex- 
ternally in  relaxation  of  the  uvula,  tonsils,  etc.;  gangrene,  indo- 
lent ulcers,  leucorrhoea,  atonic  menorrhagia,  fissure  of  the  anus, 
etc.,  etc.,  in  the  form  of  tincture,  decoction,  gargles,  lotions  and 
injections. 

Decoction  of  White  Oak  Bark,  Decoctum  ^ercus  Alba., 
is  composed  of  oak  bark,  .5J  ;  water,  Oj. 

Dose. — Of  powdered  white  oak  bark,  gr.  xxx  to  gr.  xl.  Of 
the  decoction  the  dose  is  f.^ss  to  f§j. 

Dental  Uses. — In  dental  practice  the  decoction  and  tincture 
are  employed  externally  in  the  various  forms  of  stomatitis, 
sponginess  of  the  gums,  and  relaxed  condition  of  the  mutous 
membrane  of  the  mouth  and  fauces. 

QUILLAYA  SAPONARIA— QUILLAIA  BARK. 
SOUTH    AMERICAN    SOAP    TREE    BARK. 

Source. — Quillaia  Bark  is  obtained  from  an  evergreen  tree  of 
the  natural  order  Rosacece — rose  order,  growing  in  Chili  and  Peru, 
the  inner  bark  being  employed. 


536 


DENTAL  MEDICINE. 


Medical  Properties  and  Action. — Quillaia  bark,  when  bruised  and 
macerated  in  water,  imparts  to  that  liquid  the  property  of  frothing 
like  soap  solution  when  agitated,  which  is  owing  to  the  saponaria 
in  the  bark,  the  same  principle  which  imparts  a  similar  property 
to  soapwort — saponaria  officinalis.  Quillaia  contains  no  tannic 
acid  or  other  bitter  principle,  and  is  an  article  of  commerce,  be- 
ing imported  in  large  quantities  for  cleansing  grease  from  cloth, 
as  it  does  not  change  the  color  of  silken  or  woolen  goods ;  it  is 
also  used  for  cleansing  the  hair,  which  it  is  supposed  to  preserve 
and  beautify.  When  the  powder  is  snuffed  up  the  nostrils,  it 
causes  sneezing  and  a  profuse  nasal  discharge. 

Therapeutic  Uses. — Quillaia  bark  has  been  employed  as  a 
febrifuge,  to  arrest  excessive  secretion,  as  an  application  to  ulcers, 
as  a  remedy  for  colds  in  the  head,  when  it  is  used  as  a  sternutatory, 
in  the  form  of  powder. 

The  tincture  is  composed  of  quillaia  bark  i  part ;  alcohol  5 
parts ;  it  is  also  used  in  the  form  of  infusion  and  fluid  extract. 

Dental  Uses. — Quillaia  bark,  in  the  form  of  powder,  tincture 
and  fluid  extract,  is  employed  as  an  ingredient  of  mouth  washes, 
for  its  frothy  and  detergent  properties ;  it  is  also  used  as  an  Ap- 
plication to  chronic  ulcers  of  the  mouth,  and  to  arrest  excessive 
secretion  of  the  mucous  membrane  of  the  mouth. 


DENTAL  FORMULA. 


Detergent  Mouth  Wash. 
Am.  Journ.  Pharm. 
R.     Pulv.  potassii  bicar- 

bonatis ^^ss 

Mellis ^iv 

Alcoholis ^ij 

Olei  caryophylli  .    .  q.  s. 
Olei  gaultheriae, 
Quillaiae  saponarise 

(fluid  ext.)  .  aa  .  .^j 
Aqua  destillatse   .    .  3  ix.  M. 

To  be  used  after  the  removal  of  sali- 
vary calculus. 


For  a  Mouth  Wash. 

R .     Pulv.  quillaia^  sapona- 

riae .^iv 

Glycerini ^  iij 

Alcoholis  dilutus  suffi- 
cient for  two  pints. 
Olei  gaultherijE     .    .  gtt.xx 
Olei    menthse    .    .    .  gtt.xx.     M. 
Macerate  tlie  soap  bark  in  the  mix- 
ture of  glycerine  and  alcohol  for  three 
days,  and  filter  through  a  little  mag- 
nesia previously  triturated  with  the  vol- 
atile oils. 


SULPHATE  OF  QUININE. 


537 


For    Itijlained    Gums     and    Mucous 
Alevibrane. 

Prof.  Chapin  A.  Harris. 


R .     Quillaire  saponarire 


S^i'J 


Pyrethri, 

Radicis  iridis, 

Acidi  benzoici, 

Cinnamomi     .    .    .  iia 

l\ 

Acidi  tannici    .    .    . 

p^iv 

Sodii  boratis     .    .    . 

■^iv 

Olei   gaultherize  . 

f.^ij 

Olei  menthae    .    .    . 

f  ^iv 

Cochineal     

3"J 

Saccliari  albi     .    .    . 

Ibj 

Alcoholis 

Oiij 

Aquae  purse   .... 

.  Ov. 

M. 


Digest  for  six  days  and  filter. 
SiGNA. — To   be  used  as  a  gargle  or 
mouth  wash. 

Mouth  Wash. 
Dr.  \V.  H.  Fdwler. 
R .     Fluid  Ext.  Soap  Tree 

Bark l^^Yz 

Alcohol 5  ss 

Glycerine _^jss 

Haniamelis        (Pond's 

Extract) _^iij 

Oil  of  wintergreen  .    .  tTtviij 
Oil  of  cloves    ....  TTLv 

Soft  water ^  viij. 

Dissolve  the  oils  in  the  alcohol  and 
then  add  the  other  ingredients. 


QUININ.^  SULPHAS— SULPHATE  OF  QUININE. 

Derivation. — The  two  important  alkaloid  principles  of  cin- 
chona are  quinia  and  cinchonia.,  which  exist  in  combination  with 
kinic  acid.     (See  Cinchona.) 

Sulphate  of  Quinine  is  obtained  by  boiling  the  powdered 
yellow  cinchona  bark  in  water  acidulated  with  hydrochloric  acid, 
bv  which  the  alkaloid  quinine  is  separated  from  kinic  and  other 
acids,  and  forms  a  soluble  hydrochlorate  or  muriate,  the  salt  be- 
ing decomposed  and  the  quinine  precipitated  by  the  addition  of 
lime ;  sulphuric  acid  is  added,  after  digestion  in  boiling  alcohol, 
which  dissolves  the  quinine,  and  the  solution  is  boiled  with  ani- 
mal charcoal,  filtered  and  allowed  to  crystallize.  Sulphate  of 
quinine  is  in  the  form  of  colorless,  very  light  and  silky  crystals, 
which  are  readily  soluble  in  alcohol  and  in  water  acidulated  with 
sulphuric  acid,  but  insoluble  in  ether.  It  has  an  intensely  bitter 
taste,  and  is  inodorous. 

Medical  Properties  and  Action. — Sulphate  of  quinine  is  a  very 
valuable  tonic  and  antiperiodic,  also  antiseptic  and  stimulant.  In 
small  doses  it  increases  the  fullness  of  the  pulse  and  action  of 
the  heart,  and  improves  the  tonicity  of  the  capillary  vessels,  and 
is  diffused   into  various  parts  of  the  system  with  great  rapidity. 


538  DENTAL  MEDICINE. 


In  large  doses  it  depresses  the  action  of  the  heart,  lowers  the 
blood  pressure,  and  enfeebles  as  well  as  diminishes  the  beats  of 
the  pulse.  As  it  accumulates  in  the  brain,  it  causes  a  fullness  in 
the  head,  a  constricted  feeling  about  the  forehead,  a  buzzing  or 
ringing  in  the  ears — tinnitus  aurium^  giddiness,  vertigo  and  deaf- 
ness, which  may  be  permanent  if  the  agent  is  taken  in  excessive 
quantity  ;  also  amaurosis  and  amblyopia  may  be  caused  by  full 
doses.  Poisonous  doses  cause  intense  headache,  dilated  pupils, 
delirium,  coma  and  convulsions.  Some  five  hours  are  required 
to  bring  about  the  greatest  effect  of  quinine,  although  it  can  be 
detected  in  the  urine  in  about  half  an  hour  after  it  is  taken  into 
the  stomach,  and  elimination,  chiefly  by  the  kidneys,  is  not  com- 
pleted in  a  less  time  than  48  hours,  although  the  principal  portion 
is  excreted  in  12  hours. 

Therapeutic  Uses. — Quinine  is  extensively  employed  in  peri- 
odical diseases  of  a  malarial  origin,  such  as  intermittent  fever, 
neuralgia  of  various  forms,  as  enteralgia,  hepatalgia,  nephral- 
gia, gastralgia,  sciatica,  angina  pectoris,  and  in  cases  of  debility, 
pneumonia,  pleurisy,  endocarditis,  pyaemia,  erysipelas,  puerperal 
fever,  cerebro-spinal  meningitis,  eruptive  fevers,  etc.,  etc.,  but 
the  most  important  use  of  quinia  is  for  the  treatment  of  malarial 
diseases. 

Dose. — Of  sulphate  of  quinine,  gr.  j  to  3j,  in  aromatic  water, 
by  the  aid  of  aromatic  sulphuric  acid,  and  also  as  an  enema,  or 
hypodermically.  Pills  may  be  made  by  combining  24  grains  of 
sulphate  of  quinine  with  14  grains  of  clarified  honey,  and  divid- 
ing into  24  pills.     Pills  can  also  be  made  with  glycerine. 

Dental  Uses. — Sulphate  of  quinine  is  internally  employed  in 
dental  practice  in  reducing  inflammation  of  the  peridental  mem- 
brane when  resorted  to  in  the  early  stages  of  the  disease,  and  be- 
fore effusion  of  inflammatory  products,  cell  proliferation  and  es- 
cape of  the  white  blood  corpuscles  have  occurred;  also,  in 
hypersensitiveness  of  dentine — three  or  four  grain  doses  every 
four  hours,  until  thirty  grains  have  been  taken  (Klump).  The 
treatment  of  facial  and  other  neuralgic  affections,  especially  when 
of  malarial  origin,  in  cancrum  oris,  for  its  tonic  and  stimulant 
effects,   in   aphthous   ulcerations  of  the   mouth   and  in   scurvy. 


RESORCIN.  539 


where  the  system  is  much  debilitated,  and  externally  as  an  ingre- 
dient ®f  dentifrices,  for  its  tonic  and  stimulating  properties. 

DENTAL    FORMULAE. 

For    Facial  Neuralgia  from  Dental       p^^  Neuralgia  from  Dental  Disturb- 

Disturbaiice.  atice. 

Barrett.  ^'  ^^  ^-  ^jOrgas. 

R.     Ferrietquin.(cit)  .    .  ^ij  R-     Quininse  sulphatis  .    .  gr.x 

Syrup  aurantii     .    .    .  5J  ^^"*  sulphat.  exsic.  .  gr.v 

Aqua  dest gj  Acidi  arseniosi  .    .    .  gr.ss 

Elixir  calisayK   .    .    .  ,^ij.  M.                Ext.  nucis  vomicae .   .gr.v.        M. 

„  r-      \.  ^        •        1-  Ft.  pil.  No.   XX. 

SiGNA. — Coch.  parv.  ter  in  die.  ^ 

SiGNA. — One  pill  every  four  hours. 


For  Neuralgia  Associated  with 
Ana  f Ilia. 


For  Acute  Periodontitis. 


R.     Quininse  sulph.   .    .    .  ^ss 
Garretson.  Acidi  sulph.  aromat.  .  ^ij 

R.     Tinct.  ferri  chloridi  .    .  _^j  Elix.  calisaya  bark  .   .   ^xiv.    M. 

Quininoe  sulphatis    .    .  ^j.       M.       Signa.— A  tablespoonful  every  two  or 
SiGN'A. — Teaspoonful  four  times  daily.  three  hours. 

For  Acute  Alveolar  Abscess  or  Periodic  Supra-orbital  Neuralgia. 
Cassidy. 

R.     Quinise  sulphatis gr.xv 

Ft.  capsules  No.  5. 
SiGNA.  — Take  one  every  two  hours. 


RESORCIN. 

Derivation. — Resorcin  is  a  chemical  compound  of  the  phenol 
group  and  aromatic  series,  to  which  carbolic  acid  belongs.  It  is 
obtained  from  certain  resins  by  the  action  of  fusing  alkalies,  and 
is  in  the  form  of  tabular,  prismatic,  shining  crystals,  somewhat 
sweetish  to  the  taste,  followed  by  a  slight  pungency.  Resorcin 
is  very  soluble  in  water,  95  parts  in  loO,  and  to  a  less  degree  in 
alcohol,  ether,  glycerine  and  vaseline ;  chloroform  and  carbon 
sulphide  will  not  dissolve  it.  It  darkens  on  exposure  to  the  air, 
and  is  phosphorescent  when  rubbed  in  the  dark.  Its  odor  is 
somewhat  similar  to  that  of  phenol,  but  not  so  strong. 


540  DENTAL  MEDICINE. 


Medical  Properties  and  Uses. — Resorcin  acts  somewhat  similar 
to  quinine,  although  it  differs  from  the  latter  in  its  lethal  effects. 
Quinine,  carbolic  acid,  and  salicylic  acid  promote  its  effects; 
atropine  antagonizes  it.  Through  its  action  on  the  nervous  sys- 
tem it  greatly  increases  in  frequency  the  respiration,  which  be- 
comes convulsive  and  spasmodic,  and  afterward  weak,  but  rapid. 
It  also  increases  the  action  of  the  heart,  causes  the  pulse  to  be- 
come weak  and  irregular.  It  is  eliminated  by  the  urine  quite 
rapidly.     It  has  no  irritating  action  on  mucous  membranes. 

Therapeutic  Uses. — Resorcin,  on  account  of  its  less  irritating 
property,  is  considered  preferable  to  carbolic  acid  for  internal  use 
and  subcutaneous  injection.  It  is  employed  internally  in  catarrh 
of  the  stomach,  ulceration,  gastralgia,  fermentative  indigestion, 
fevers,  for  its  antiseptic  and  antipyretic  actions,  and  ulcerative 
endocarditis,  etc.,  etc.  Locally,  on  account  of  its  antiseptic 
properties,  in  diphtheria,  in  syphilitic  and  other  sloughing  sores, 
and  anthrax,  in  the  form  of  crystals  or  powder,  and  in  the  form 
of  spray  in  catarrhal  and  ulcerating  affections  of  the  nose  and 
throat ;  in  solution,  on  account  of  its  antiseptic  action,  it  is  used 
for  dressing  putrid  and  atonic  wounds,  and  is  combined  with 
water,  glycerine  and  alcohol ;  it  is  also  used  in  pomades. 

A  compound  composed  of  resorcin  and  salicylic  acid  heated 
together,  is  known  as  "  Salicyl  Resorcin-Ketone,"  and  is  anti- 
septic to  a  degree,  as  it  limits  the  development  of,  rather  than  de- 
stroys, septic  germs.  It  is  soluble  in  glycerine  and  alcohol,  and 
is  neither  poisonous  nor  disagreeable  to  the  taste. 

Dose. — Of  resorcin,  gr.v— xv.  Five  grains  every  two  hours  in 
an  ordinary  case. 

Dental  Uses. — Resorcin  is  a  valuable  antiseptic  in  dental  prac- 
tice, and  may  be  applied  with  advantage  in  all  cases  where  anti- 
septics are  indicated.  A  ten  per  cent,  solution  of  resorcin  is 
recommended  in  cases  of  chronic  alveolar  pyorrhoea  (after  cleans- 
ing the  pockets  with  peroxide  of  hydrogen)  where  there  is 
impaired  circulation  of  the  tissues.  (See  Antiseptic  Uses  of 
Carbolic  Acid.) 


RHUBARB. 


541 


DENTAL    FORMULAE. 


3J 

I  viij.     M. 
ash  after  re- 


For  Alveolar  Pyorrhcea. 
Dr.  a.  W.  Harlan. 

R .    Resorcin 5  ij 

Acidi  carbolici 
Glycerini     .    . 
Aqure  q.  s.    .    . 
SiGNA. — Use  as  a  mouth  \v: 

moving  all  deposits,  and  the  adjacent 
carious  or  necrosed  bone. 

A  few  drops  of  oil  of  peppermint 
or  any  other  desirable  oil  may  be 
added  to  the  above. 

For  Alveolar  Pyorrhoea. 
Dr.  a.  W.  Harlan. 
R.    Resorcin  .    .  gr.xxx 

Acidi  tannici   ....  gr.v 


Olei  cassia tit'' 

Glycerini *j 

Aquae  destillatae  .    .    ■   J  ij.        M. 

Signa. —  Inject  with  a  syringe  into  the 
remains  of  the  pockets  in  the  after- 
treatment. 


For  Mucous  Patches  of  the 
Mouth. 

Dr.  a.  \V.  Harlan. 

R .    Resorcin gr-xl 

Aquffi  destillatae  .    .    .  ^ss.        M. 
Signa. — Dry  surface   and    paint  with 
above. 


RHEUM— RHUBARB. 

Source. — The  root  of  Rheum  officinale.  It  contains  two  acids, 
rheo-tannic  and  rheumic,  a  resin,  phaoretin.,  and  an  acid,  chryso- 
phan  or  chrysophani. 

Medical  Properties  and  Therapeutic  Uses. — Rhubarb  possesses 
tonic  and  astringent  as  well  as  purgative  properties.  In  small 
doses,  as  a  tonic,  it  promotes  the  appetite  and  digestive  power, 
and  by  virtue  of  the  tannic  acid  it  contains,  is  astringent.  The 
purgative  principle  it  possesses  enables  sufficient  doses  of  rhu- 
barb to  act  as  a  cathartic,  producing  stools  which  are  of  a  yel- 
lowish-brown color,  and  soft,  but  not  watery.  It  has  no  ten- 
dency to  cause  gastro-enteric  inflammation.  It  is  now  classed 
among  the  cholagogues,  as  it  increases  the  flow  of  bile  and  the 
intestinal  secretions,  which  is  due  to  phaeoretin — rhubarb  resin. 
Its  coloring  matter  not  only  stains  the  stools,  but  also  the  per- 
spiration, milk  of  nursing  women,  to  which  it  gives  a  bitter  taste 
and  purgative  principles,  and  the  urine.  It  is  employed  with 
benefit  in  diarrhoea  caused  by  the  accumulation  of  undigested 
food  in  the  intestines,  hemorrhoids  accompanied  by  constipation, 
dyspepsia  with  deficient  biliary  and  intestinal  secretions,  the 
summer  diarrhoea  of  children  in  the  form  of  the  aromatic  svrup. 


542  DENTAL  MEDICINE. 


and  in  catarrh  of  biliary  ducts  with  jaundice ;  and  the  chewing 
of  rhubarb  root  is  beneficial  in  habitual  constipation;  its  frequent 
use,  however,  is  objectionable  on  account  of  the  astringent  after- 
effect, which  in  the  rhubarb  pill  is  remedied  by  the  soap. 

Dose. — Of  Extractum  Rhei — Extract  of  Rhubarb,  grs.  x  to 
grs.  XV.  Of  Extractum  Rhei  Fluidum — Fluid  extract  of  rhubarb, 
5ss  to  5i«  Of  Pilules  Rhei — Rhubarb  pills,  each  pill  consists  of 
grs.  iij  of  rhubarb  and  gr.  j  of  soap.  Of  Pilules  Rhei  Com- 
posites— Compound  pills  of  rhubarb,  consisting  of  rhubarb,  aloes 
and  myrrh.  Dose,  2  to  4  pills.  Of  Syrupus  Rhei — Syrup  of 
rhubarb,  5ss  to  5ij-  Of  Tinctura  Rhei  Jromaticus — Aromatic 
tincture  of  rhubarb,  5ss  to  5ij-  Of  Tinctura  Rhei  Dulcis — 
Sweet  tincture  of  rhubarb,  5ss  to  .5ij.  Of  Vinum  Rhei — Wine 
of  rhubarb,  5j  to  5ss.  Of  Pulvis  Rhei  Compositus — Compound 
powder  of  rhubarb,  a  teaspoonful. 

RHIGOLENE. 

Derivation. — Rhigolene  is  a  product  of  the  distillation  of  petro- 
leum. In  its  composition  it  is  a  hydrocarbon,  and  is  destitute 
of  oxygen,  being  extremely  volatile  and  inflammable,  and  is  the 
lightest  of  all  liquids,  with  a  specific  gravity  of  0.625.  It  is  a 
petroleum  naphtha,  and  boils  at  700°  F.,  and  when  perfectly  pure 
should  be  almost  odorless ;  but  it  is  difficult  to  procure  anv 
specimen  that  does  not  have  the  unpleasant  odor  of  petroleum. 
It  is  colorless,  and  on  account  of  its  great  volatility  and  inflam- 
mability requires  to  be  kept  tightly  stoppered,  in  a  cool  place. 
The  storage  of  large  quantities,  except  in  very  secure  places,  is 
attended  with  considerable  risk,  and  on  this  account  it  is  some- 
what difficult  to  procure  it  outside  of  the  manufactories.  It  is 
dangerous  to  use  it  at  night  near  a  light. 

Dental  Uses. — Rhigolene  is  employed,  like  absolute  ether,  to 
produce  local  anaesthesia,  by  dispersing  it  in  the  form  of  spray, 
with  the  sprav  apparatus,  being  the  most  rapid  in  its  congealing 
effects,  and  also  the  most  easily  controlled  and  convenient  of  all 
of  the  freezing  mixtures.  As  a  local  anaesthetic  it  is  employed 
in  the  operation  of  extracting  teeth,  by  applving  it,  in  the  form 
of  spray,  to  the   parts   about  the   tooth  to  be   removed  until  a 


SALOL.  543 

blanched  surface  of  gum  is  produced.  The  spray  of  rhigolene 
is  also  applied  to  the  gum  over  the  root  of  a  tooth  affected  with 
incipient  periodontitis. 


SALOL— PHENYLIC  ETHER  OF  SALICYLIC  ACID. 

Formula.— C,,U,,0^=C,H^  (OH)  (CO.OQH^). 

Derivation. — Salol  is  obtained  by  the  combination  of  salicylic 
acid  and  phenol,  consisting  of  60  parts  of  weight  of  salicylic 
acid  and  forty  parts  of  phenol.  It  is  a  white,  crystalline  powder, 
insoluble  in  water,  without  odor  and  nearly  tasteless.  In  the 
system  it  becomes  decomposed,  yielding  salicylic  and  carbolic 
acids  in  nascent  forms. 

Medical  Properties  and  Therapeutic  Uses. — Salol  is  antiseptic, 
germicide  and  antipyretic,  and  possesses  less  poisonous  proper- 
ties than  either  salicylic  acid  or  carbolic  acid  alone ;  large  doses 
of  salol,  however,  cannot  be  administered  without  danger  of 
phenol  poisoning.  It  is  accumulative,  owing  to  its  being  ab- 
sorbed and  eliminated  slowly,  and  hence  cannot  be  given  too 
frequently. 

In  acute  and  chronic  renal  diseases,  salol  is  contra-indicated. 
It  is  employed  internally  in  disorders  of  stomach,  acute  gastro- 
enteritis, tonsilitis,  gonorrhoea,  skin  diseases,  gleet,  etc.  Exter- 
nally used,  salol  is  an  excellent  dressing  for  wounds,  ulcers, 
burns,  erysipelas  and  skin  diseases.  Camphorated  salol  is  highly 
recommended  by  Cuirllier  in  the  treatment  of  otitis.  It  can  be 
mixed  with  iodoform  or  iodol,  and  the  action  of  both  be  had 
simultaneously. 

Dose. — Gr.  v.  to  5j' 

Dental  Uses. — Mixed  with  iodoform,  aristol,  or  oxide  of  zinc, 
salol  is  successfully  used  for  capping  exposed  pulps.  It  is  also 
employed  as  a  root-filling  material  by  first  drying  out  the  root- 
canals  with  absolute  alcohol  and  hot-air,  then  liquefying  a  little 
salol  in  a  test-tube  over  a  spirit  lamp,  and  injecting  some  of  the 
liquid  by  means  of  a  warm  hvpodermic  syringe  to  the  apex  of 
each  root.  It  is  then  allowed  to  crystallize,  when  it  becomes 
very  hard. 


544  DENTAL  MEDICINE. 


For  Erythema. 
Dr.  a.  Eichler. 

R .       Saloli 3  ij 

Zinci  oxidi ^ 

Pulv.  amyli aa  ^iv 

Lanoline gj-  M. 

SANDARACA— SANDARACH. 

Source. — Sandarach  is  a  resinous  substance  obtained  from  an 
evergreen  tree — Thuya  Articulata — which  grows  in  the  northern 
part  of  Africa.  The  gum  is  in  the  form  of  small,  irregular, 
round  and  oblong  tears,  of  a  pale  yellow  color,  sometimes  brown, 
and  more  or  less  transparent,  dry  and  brittle.  It  has  a  faint, 
agreeable  odor,  which  is  increased  by  warmth,  and  a  resinous, 
somewhat  acrid  taste.  It  melts  with  heat,  diffusing  a  strong 
balsam  odor,  and  is  inflammable.  It  is  soluble  in  alcohol  and 
ether,  and  slowly  dissolves  in  warm  oil  of  turpentine.  It  con- 
sists of  three  resins,  varying  in  their  relations  to  alcohol,  ether 
and  oil  of  turpentine.  The  sandaracin  which  remains  after 
sandarach  has  been  exposed  to  the  action  of  ordinary  alcohol 
is  a  mixture  of  two  of  these  resins. 

Uses. — Sandarach  was  formerly  employed  as  a  medicinal  agent, 
and  entered  into  the  composition  of  various  ointments  and 
plasters,  but  its  use  is  now  restricted  to  such  purposes  as  the 
composition  of  a  varnish,  ingredient  of  incense,  etc.  After  the 
erasion  of  ink  marks,  its  powder,  if  rubbed  on  such  a  surface, 
will  prevent  fresh  ink  marks  from  spreading. 

Dental  Uses. — In  dental  practice,  sandarach,  dissolved  in 
alcohol,  forms  a  varnish  for  coating  the  surface  of  plaster  models, 
etc. ;  it  is  also  used  for  checking  secretions  from  the  gums  during 
the  operation  of  filling  teeth,  either  applied  as  a  coating  to  the 
surface,  or  on  bibulous  paper  saturated  with  it.  It  is  also  em- 
ployed to  saturate  cotton  to  be  used  as  a  temporary  filling  in 
cavities  of  the  teeth,  for  the  protection  of  medicinal  applications. 

DENTAL    FORMULA. 

Tra7isparent  Sandarach    Varnish. 

R .    Gum  sandarach ^  y 

Alcohol qt.j. 

Mix  and  digest  over  a  moderate  heat  until  the  sandarach  is  dissolved. 


SHELLAC.  545 

SHELI^LAC— SHELLAC. 

Source. — Lac  is  a  resinous  substance,  obtained  from  several 
varieties  of  trees  which  grow  in  the  East  Indies,  and  particularly 
from  the  Croton  Lacciferum^  and  two  species  of  the  Ficus.  It  is 
supposed  to  be  an  exudation  from  the  bark,  owing  to  the 
puncture  of  an  insect  belonging  to  the  genus  Coccus ;  it  is  also 
said  to  be  the  exudation  from  the  bodies  of  the  insects  them- 
selves. Several  varieties  are  known  in  commerce,  the  most 
common  being  the  stick-lac^  the  seed-lac  and  the  shell-lac.  Lac, 
in  its  crude  state,  consists  of  resin,  coloring  matter,  and  a 
peculiar  principle,  insoluble  in  water,  alcohol  and  ethyl,  and 
known  as  /aa«,  a  little  wax,  and  various  saline  matters  in  small 
proportion. 

Uses. — It  is  slightly  astringent,  and  has  been  recommended  as 
an  adhesive  substance  for  dressing  ulcers,  wounds,  etc.,  being 
used  by  simply  spreading  it  on  the  bandages  after  it  is  dissolved 
in  alcohol  by  a  gentle  heat.  Shellac  is  prepared  by  melting  the 
crude  lac,  straining  it,  and  pouring  it  upon  a  flat,  smooth  surface 
to  harden.  It  is  in  the  form  of  thin  fragments  of  various  sizes, 
from  half  a  line  to  a  line  in  thickness,  and  of  a  light  and  also  a 
dark  brown  color,  shining,  hard,  brittle  and  inodorous.  It  is 
insoluble  in  water,  but  freely  soluble  in  alcohol,  especially  with 
the  aid  of  heat.  It  is  employed  as  a  varnish.  In  dental  practice 
its  uses  are  the  same  as  those  of  sandarach,  but  owing  to  the 
dark  brown  color  of  the  solution,  it  is  not  so  sightly,  and  does 
not  make  a  transparent  varnish. 

DENTAL    FORMULA. 

For  a  Colored  Varnish.  For  an  Aqueous  Varnish. 

li.    Gum  shellac ^v  R-    Pulv.  shellac  .    .    •    •    .  partes  j 

Alcohol qt.j.  Sat.  solut.  boracis  .    .    .  partes  ij. 

Mix    and   digest   over   a   moderate  Mix    by   shaking   together ;    it   will 

heat  until  thoroughly  dissolved.  give  a  starch  gloss. 

Shellac  may   be   dissolved   without   the   aid   of  alcohol,  by   a 

saturated  solution  of  borax  in  water.     This,  however,  does  not 

give  a   very   strong   solution.      To  prevent   cracking  when  the 

shellac  is  dissolved  in  alcohol,  add  a  little  castor  oil  ;  if  in  water, 

35 


546  DENTAL  MEDICINE. 


add  glycerine.  Clear  shellac  varnish  may  be  prepared  by  first 
making  an  alcohol  solution  of  shellac  in  the  usual  way,  and  then 
adding  a  little  benzole,  and  the  mixture  well  shaken.  In  from 
24  to  48  hours  the  fluid  will  have  separated  into  two  distinct 
layers,  an  upper  alcoholic  stratum,  perfectly  clear,  and  of  a  dark- 
red  color,  while  under  it  is  a  turbid  mixture  containing  the  im- 
purities. The  clear  solution  is  drawn  off  with  a  pipe,  or  may 
be  decanted. 

SILVER  SULPHO-CARBOLATE— SILVER  SULPHO-PHENATE. 

Derivation. — Silver  sulpho-carbonate  is  prepared  from  silver 
carbonate  and  sulpho-carbolic  acid.  It  occurs  in  the  form  of 
white,  prismatic  needles,  containing  twenty-eight  per  cent,  of 
silver.  It  must  be  protected  from  light  and  air  to  prevent  it 
from  splitting  up  into  metallic  silver  and  phenol. 

Therapeutic  and  Dental  Uses. — It  is  said  to  possess  valuable 
antiseptic  properties,  and  to  be  preferable  to  nitrate  of  silver  for 
such  purposes  as  the  latter  agent  is  employed,  on  account  of  its 
non-corrosive  action.  Dr.  Harlan  speaks  of  it  acting  very  well 
in  deep  pyorrhoea  pockets.  It  is  soluble  in  water  in  three  to  ten 
per  cent,  solutions. 

SOD^  PHENAS— PHENATE  OF  SODIUM. 
CARBOLATE    OF    SODIUM PHENOL    SODIQUE. 

Formula. — CgHgNaO. 

Derivation. — Phenate  or  Carbolate  of  Soda  is  obtained  by  mix- 
ing one  part  of  caustic  soda  with  five  parts  of  carbolic  acid,  and 
a  small  quantity  of  water,  and  evaporating  the  solution,  the  re- 
sult being  a  saponaceous  mass  of  acicular  crystals  of  a  light  pinkish 
color,  which  are  converted  by  the  heat  into  a  fluid  of  an  oily 
consistence.  It  is  freely  soluble  in  creasote,  carbolic  acid  and 
water. 

Medical  Properties  and  Action. — Phenate  of  soda  is  hemostatic, 
antiseptic  and  disinfectant. 

Therapeutic  Uses. — It  is  internally  administered  in  the  form 
known  by  the  French  name  of  Phenol  Sodique.,  in  doses  of  gtt. 
viij  or  gtt.  X  in  a  glass  of  water,  in  typhus  and  typhoid  fevers,  as 


BICARBONATE  OF  SODIUM.  547 

a  preventive  of  cholera,  in  plagues,  cholera  infantum,  etc. ;  ex- 
ternally, it  is  a  valuable  styptic  in  local  hemorrhage,  and  as  a 
dressing  for  wounds,  burns,  chilblains,  excoriations,  varicose 
veins,  venomous  stings  and  bites,  and  as  a  disinfectant  in  throat 
affections,  leucorrhoea,  diphtheria,  scarlatina,  smallpox,  ozasna,  etc. 
Dental  Uses. — Phenate  of  soda  is  useful  in  dental  practice,  as 
an  astringent  and  styptic  in  hemorrhage  following  the  extraction 
of  teeth,  and  to  relieve  the  soreness  of  such  an  operation,  as  it 
promotes  the  rapid  absorption  of  the  extravasated  blood,  and  the 
healing  and  hardening  of  the  gums.  It  is  applied  on  a  pellet  of 
cotton,  or  in  solution  with  water,  and  acts  as  a  sedative  and  an- 
tiphlogistic as  well  as  a  hemostatic,  and  has  little  or  no  escha- 
rotic  action.  For  soft  and  spongy  gums  it  forms  an  efficient  gargle 
or  mouth  wash,  and  can  be  employed  for  this  purpose  in  its  full 
strength,  in  the  form  of  phenol  sodique,  or  diluted  with  from  one 
to  twelve  parts  of  water.  When  applied  on  cotton  to  an  ex- 
posed and  inflamed  pulp,  it  relieves  odontalgia.  It  is  also  em- 
ployed in  aphthous  ulcerations  of  the  mouth,  and  as  a  disinfectant 
in  offensive  breath,  in  the  proportion  of  a  teaspoonful  to  a  glass 
of  water. 

DENTAL    FORMULAE. 

Phenol  Sodicjue. 

R.        Pure  melted  carbolic  acid 5  parts 

Solution  of  caustic  soda,  specific  gravity  1 :  332     .    .     I  part 

Distilled  water 5  parts. 

Mix. 

A   Phenol  Sodique  Preparation. 

R.        Acidi  carbolici   .    .        gr.clxxxviij 

Sodoe  caustic gr.xxxj 

Aquae ^iv.  M. 

SiGNA. — To  be  applied  on  a  pellet  of  cotton,  or  as  a  mouth  wash,  diluted 
to  meet  requirements  of  case. 

SODII  BICARBONAS— BICARBONATE  OF  SODIUM. 
SESQUICARBONATE    OF    SODIUM. 

Formula.— "^^nCOy 

Derivation. — Bicarbonate   of  sodium  is  obtained   by  saturating 
the   carbonate   of  sodium  with  carbonic  acid.      It  is  in  the  form 


548  DENTAL  MEDICINE. 

of  a  white,  opaque  powder,  freely  soluble  in  water,  with  a  mild, 
slightly  alkaline  taste. 

Medical  Properties  and  Action. — Bicarbonate  of  sodium  is  an- 
tacid, alterative,  lithontriptic,  and  from  its  mildness  and  non- 
irritating  qualities  is  more  pleasant  to  the  taste  and  to  the  stomach 
than  the  carbonate.  It  is  extensively  used  in  the  preparation  of 
soda  and  seidlitz  powders. 

Therapeutic  Uses. — Bicarbonate  of  sodium  is  internally  admin- 
istered in  neuralgia  connected  with  acidity  of  the  stomach,  cardi- 
algia,  flatulence  and  vomiting,  dyspepsia,  diarrhcea,  diseases  of 
the  skin,  albuminuria,  calculous  disease,  etc.  Externally  in  dis- 
eases of  the  skin  of  a  scaly  and  papular  nature,  ecthyma,  ring- 
worm, and  sprinkled  over  burns  and  scalds,  and  combined  with 
an  equal  part  of  common  salt,  for  stings  of  venomous  insects. 

Dose. — Of  bicarbonate  of  sodium,  gr.  v.  to  5jj  in  carbonic  acid 
water,  or  with  sugar  and  mucilage. 

Effervescing  Powders. — Puheris  Effervescentes  are  composed 
of  tartaric  acid,  gr.  xxv,  in  one  paper,  and  bicarbonate  of  sodium, 
XXX,  in  another  paper. 

Dental  Uses. — Bicarbonate  of  sodium  is  employed  in  dental 
practice  to  relieve  neuralgia  of  an  acid  origin,  in  which  a  full 
dose  often  proves  very  serviceable ;  in  aphthae  of  children  it  is 
often  combined  with  a  little  rhubarb  and  proves  very  efficacious. 
Externally  it  instantly  relieves  odontalgia  when  a  small  portion 
of  the  powder  is  applied  to  the  irritable  pulp  and  properly 
secured.  It  is  also  useful  for  neutralizing  the  acidity  of  the  oral 
fluids,  especially  when  such  a  condition  is  the  result  of  preg- 
nancy.    It  also  forms  an  antacid  ingredient  in  dentifrices. 

Dr.  E.  C.  Kirk  recommends  a  thick  paste  of  sodium  carbonate 
as  a  local  sedative  and  obtundent  of  hypersensitive  dentine,  its 
application  to  be  made  to  a  dry  cavity  and  repeated  when  neces- 
sary. In  acute  periodontitis,  applied  to  the  gums  after  a  slight 
puncture,  it  will  often  afford  speedy  relief  from  the  pain.  As  a 
chemical  disinfectant  and  antiseptic.  Dr.  Leffmann  considers 
sodium  carbonate  to  be  of  great  value  in  the  treatment  of  devita- 
lized teeth  containing  semi-putrescent  pulps  and  food  debris^  to 
be  followed  by  injections  of  warm  water. 


BORATE  OF  SODIUM.  549 

DENTAL    FORMULA. 

For  Periodontitis,  etc, 
Carl  Seiler. 

R .        Sodii  bicarb 5  viij 

Sodii  bibor 3  viij 

Sodii  benzoate 

Sodii  salicylate aa  gr.xx 

Eucalyptol 

Thymol aa  gr.x 

Menthol gr.v 

01.  Gaultheria gtt-vj 

Glycerini ^  viiiss 

Alcoholis ^  ij 

AquK q.  s.  16  pints.    M. 

SiGNA. — Use  as  an  antiseptic  spray. 

SODII  BORAS— BORATE  OF  SODIUM. 
BORAX. 

Formula.— ^2i.^,0^\\QY{,0. 

Source. — Borax  is  a  native  salt,  but  can  be  obtained  artificially 
by  boiling  together  native  boracic  acid  (found  in  Italy),  and  car- 
bonate of  soda.  California  furnishes  the  borax  used  in  this 
country.  It  is  in  the  form  of  colorless  crystals,  which  effloresce 
somewhat  in  dry  air,  and  are  freely  soluble  in  water  and  glyce- 
rine, but  insoluble  in  alcohol,  with  an  alkaline  reaction,  and  a 
sweetish  alkaline  taste.  It  dissolves  fibrine,  albumen,  casein  and 
uric  acid. 

Medical  Properties  and  Action. — Borax  is  refrigerant,  diuretic, 
detergent,  antacid  and  emmenagogue,  and  has  been  employed  as 
a  solvent  for  calculi.  It  resembles  in  its  action  carbonate  of 
soda,  and  by  its  mild  alkaline  qualities  it  improves  the  condition 
of  the  skin  and  mucous  membranes.  In  excessive  or  large  re- 
peated doses  it  is  injurious,  causing  nausea  and  vomiting,  and  a 
scorbutic  condition  of  the  body. 

Therapeutic  Uses. — Borax  is  internally  administered  in  infantile 
diarrhoea,  in  the  form  of  an  enema ;  also,  as  a  solvent  for  calculi, 
and  in  dropsy,  etc.,  but  its  chief  use  is  as  an  external  application. 
Externally  it  is  applied  as  a  detergent  in  cutaneous  affections, 
ulcerations,  pityriasis,  to  remove  freckles,  to  allay  itching,  etc.,  etc. 


550  DENTAL  MEDICINE. 


Dose. — Of  borate  of  sodium,  gr.  ij  to  3j. 

Glycerite  of  Borate  of  Sodium — Gly centum  Sodii  Boratis — Gly- 
cerinum  Boracis — is  composed  of  borax,  5ij  ;  glycerine,  Oss,  and 
is  a  useful  application  to  the  mouth  and  throat. 

Honey  of  Borate  of  Sodium — Mel  Sodii  Boratis — Mel 
Boracis — is  composed  of  borax,  5j  ;  clarified  honey,  .5J,  and  is 
also  useful  as  a  detergent  application  to  the  mouth  and  throat. 

Boricine. — Boricine  is  a  combination  of  equal  parts  of  borax 
and  boracic  acid,  forming  a  tetraborate  of  sodium,  which  is 
neither  toxic,  caustic  nor  irritant.  It  has  no  odor,  and  gives  a 
saturated  solution  at  i6  per  cent.  Mr.  Emile  Denis  recommends 
boricine  as  a  disinfectant  of  root  canals,  abscess  of  antrum,  and 
diseased  mucous  membrane. 

Dental  Uses. — Borax,  mixed  with  sugar  or  honey,  is  a  very 
useful  application  for  aphthae  and  other  ulcerations  of  the  mouth, 
for  which  it  may  be  mixed  with  sugar  in  the  proportion  of  one 
part  to  seven,  or  in  the  form  of  mel  boracis.  In  mercurial  stoma- 
titis, an  aqueous  solution  of  borax,  or  the  mel  boracis.,  forms  an 
efficient  gargle.  Borax  is  also  a  useful  application  in  fissured  or 
cracked  tongue.  Borax  is  also  added  to  sage  and  balm  teas,  to 
form  gargles. 

In  the  dental  laboratory,  borax  is  employed  as  a  flux  in  melt- 
ing metals,  such  as  gold  and  silver,  and  in  the  process  of  solder- 
ing metals.  It  is  also  employed  to  harden  plaster  casts  or 
models,  the  model  being  well  dried  and  then  immersed  for  a  few 
minutes  in  a  solution  of  borax  in  boiling  water,  which  renders  it, 
when  cool,  hard  and  durable.  (Solutions  of  carbonate  of  soda 
and  alum  are  used  for  the  same  purpose.)  Dr.  J.  L.  Williams 
considers  borax  a  valuable  application  to  the  teeth  of  pregnant 
women  to  counteract  acidity  of  the  fluids  of  the  mouth.  He 
recommends  the  use  of  the  powder  applied  to  the  teeth  and 
allowed  to  remain  half  a  minute  or  so,  and  then  brushed  off  by  a 
whirling  motion  of  the  brush,  not  with  a  horizontal  movement. 
Also  useful  to  sterilize  instruments. 

Impression  trays  may  be  perfectly  cleaned,  after  using  model- 
ing composition,  by  boiling  in  sal-soda  water. 


SALICYLATE  OF  SODIUM.  551 


DENTAL  FORMULAE. 

A  Mild,  Detergent  Gargle.  pgy.  Fissured  or  Cracked  Tongue. 

R.     Sodii  boratis  .    •    .    .  5i  r>       c  j ••  u      »•  -x- 

^,        .   .  %   .  »,        R-     Sodii  boratis  .    .    .    .  ^\ 

Glycerini 5vi.  M.  „,        .   .  %..  ., 

•'  ^  '  Glycerini ^j.  M. 

For    Aphthous   Ulcerations,    Parasitic  r^    ^_  j  ,  ,.  , 

^  r~,    ,  ,        .     ^     J.  1  o  be  used  as  a  lotion  or  gargle. 

Formations,  and  Diphtherettc  Condi- 
tions. ^^  Fissured  Tongue. 

\l.     Sodii  boratis  .    .    .    .  ^ij  J-  W.  White. 

Syrupi  aurantii  .    .    .  3  iv  R .     Sodii  boratis  ....  gr.xl 

Aquae  destillatae    .    .  ^iv.        M.  Glycerini ^j 

SiGNA— To  be  applied  as  a  lotion  or  Aquae  destillatae    .    .  |iv.       M. 

mouth  wash,  stimulant  and  antiseptic.  To  be  used  as  a  gargle. 

For  Aphthous  Ulcerations,  etc.,  etc.  ^  Detergent  Alkaline  Gargle. 

R.     Sodii  sulphitis  .    .    .    .  3J  g.     Sodii  boratis  .    .    .    .  ^\v 

Glycerini ^j.       M.  Glycerini, 

SiGNA. — To   be   used   as   a   lotion   or  Tincturse  myrrhae  aa  5  ss 

mouth  wash.  Aquae  destillatae   .    .  ^  x.         M. 

Collyrium. 
Dr.  Potter. 

R .         Sodii  boratis gr.x 

Aquae  camphorae ^ij 

Mucil.  cydonii 

Aquae  destillatae aa^ss.  M. 

Fiat  collyrium. 

SiGNA. — Eye-water :     A  few  drops  put  into  the  eye  3  or  4  times  daily. 

SODII  SALICYLAS— SALICYLATE  OF  SODIUM. 

Formula.— iNzC-jUJJ^+n^O. 

Derivation. — Salicylate  of  Sodium  is  prepared  by  the  addition 
of  salicylic  acid  to  a  solution  of  bicarbonate  of  sodium ;  when 
the  latter  is  in  excess  the  solution  is  brownish  or  purplish  in 
color,  and  has  a  strong  odor  of  wintergreen.  The  formula  is  as 
follows  :  I^.  Acidi  salicylic!,  5ij ;  sodii  bicarb.,  5j  >  aquas, 
Sij.     M. 

Dose. — A  teaspoon ful,  every  2,  3  or  4  hours. 

Dental  Uses. — Employed  as  an  internal  remedy  for  odontalgia, 
periodontitis  and  the  pain  of  carious  dentine,  affording  temporary 
relief  for  several  days.  Dr.  Thomas  recommends  doses  of  ten 
grains  every  half  hour  for  the  relief  of  odontalgia. 


552  DENTAL  MEDICINE. 


For   Aphthous    Stomatitis. 

R .         Salicylate  of  soda 20  parts 

Distilled  water 100  parts  dissolve. 

SiGNA. — Paint  the  inflamed  parts  five  or  six  times  a  day,  particularly  after 

meals.     The  mouth  should  previously  be  well  rinsed  out  with  tepid 

water. 

SODII  SULPHIS— SULPHITE  OF  SODA. 

Formula.— ^z.^O^+'jUf). 

Derivation. — Sulphite  of  Soda  is  prepared  by  passing  sulphur- 
ous acid  into  a  solution  of  carbonate  of  soda,  and  evaporating 
free  from  air.  The  sulphurous  acid  unites  with  the  soda  of  the 
carbonate,  to  form  the  sulphite  of  soda,  and  the  carbonic  acid 
escapes.  On  cooling,  the  salt  crystallizes  in  white  prismatic 
crystals,  and  should  be  kept  well  stoppered,  as  it  changes  on  ex- 
posure into  sulphate  of  soda. 

Medical  Properties  and  Jetton. — Sulphite  of  soda  is  a  disinfectant 
and  deodorizer,  and  its  action  and  uses  are  similar  to  those  of  the 
other  sulphites,  hyposulphites  and  sulphurous  acid. 

Dose. — Of  sulphite  of  soda,  gr.  xv  to  .5ji  three  times  a  day. 

Dental  Uses. — Sulphite  of  soda  is  sometimes  employed  in  the 
form  of  a  lotion  for  aphthous  sore  mouth  due  to  a  parasitic  vege- 
table -,  also  in  ulcerous  stomatitis,  gangrenous  stomatitis,  and  all 
suppurative  affections  of  mucous  membrane,  especially  when 
they  are  sustained  by  zymotic  influences  or  invisible  organisms. 
Dr.  E.  C.  Kirk  has  successfully  employed  sulphite  of  soda  in 
combination  with  boracic  acid,  for  bleaching  discolored  teeth. 
(See  Formula.)     His  method  is  as  follows  : 

Having  adjusted  the  rubber  dam  to  the  tooth  to  be  treated,  and 
one  adjoining  it  on  each  side,  the  cavity  of  decay  is  cleansed  of 
all  debris  and  the  root  filled  with  gold  or  gutta  percha  for  one- 
half  its  length.  The  powder,  composed  of  sulphite  of  soda  and 
boracic  acid,  is  packed  into  the  remaining  portion  of  the  pulp 
canal  and  cavity  of  decay,  leaving  just  sufficient  space  to  insert  a 
temporary  filling  of  gutta  percha  or  Hill's  Stopping.  After  the 
powder  has  been  properly  packed,  a  drop  of  water  is  permitted  to 
fall  upon  it  from  a  drop-tube  or  a  pellet  of  cotton  wrapped 
around   a  broach,  the  object  being  to  dampen  the  powder,  not  to 


R.     Sodii  sulphitis  .    .    .  gr.xxx 


SODIUM  SILICO-FLUORIDE.  553 

wash  it  out.  The  cavity  of  decay  is  then  filled  with  gutta 
percha,  and  the  patient  dismissed  until  the  next  sitting,  when  a 
second  application  can  be  made,  which  is  usually  sufficient,  ex- 
cept in  cases  where  the  walls  of  the  tooth  are  very  thick  and 
much  discolored,  when  a  third  application  may  be  necessary. 
When  the  water  is  added  to  the  powder  a  chemical  reaction  takes 
place,  the  boracic  acid  unites  with  the  sodium  of  the  sulphite  to 
form  sodium  borate,  at  the  same  time  liberating  the  sulphurous 
acid,  upon  which  the  bleaching  power  depends.  Dr.  F.  D. 
Weisse  recommends  hyposulphite  of  soda  for  abscess  of  the  an- 
trum, the  following  solution  being  injected  at  least  five  times  a 
day  :  Sulphite  of  soda,  one  drachm  to  one  ounce  of  water. 

DENTAL    FORMULAE. 

For  Aphthous  Sore  Alotith.  For  Same. 

R.     Sodii  sulphitis  .    .    .    .    3J  Dr.  Wallace. 

Aquae f^j.        M. 

SiGNA.— Apply  as  a  lotion.  Glycerinse, 

Aqua; aa^ss. 

SiGNA. — To  be  used  on  a  swab  every 
two  hours. 

For  Bleaching  Discolored  Teeth, 
Dr.  E.  C.  Kirk. 

R.         Sodii  Sulphitis gr.ioo 

Acidi  boracis gr.  70 

Mix  by  grinding  together  in  a  warm,  dry  mortar,  to  a  fine  pow- 
der, which  is  preserved  in  an  air-tight  stoppered  bottle,  and  kept 
in  a  dry  place. 
SiGNA. — (See  Dental  Uses  of  Sulphite  of  Soda.) 

SODIUM  SILICO-FLUORIDE. 

Derivation. — When  sand  is  fused  with  sodium  or.  potassium 
carbonate,  a  reaction  occurs  forming  a  silicate  of  these  metals, 
SiO.  +  NajCOg^NaoSiO,  (sodium  silicate)  +  COj. ,  The  sili- 
cates of  sodium  and  potassium  are  commonly  known  as  water- 
glass.,  and  are  soluble  in  water,  whereas  silicates  of  other  metals 
are  generally  insoluble.  When  a  mixture  of  fluor-spar  and  any 
silicious  substance,  as  sand,  is  heated  in  a  retort  with  HgSO^,  the 


55.1:  DENTAL  MEDICINE. 


resulting  gas  being  distilled  over  through  mercury  into  water, 
which  holds  if  in  solution,  and  which  is  then  filtered  to  remove 
the  free  silicon  which  precipitates,  the  result  is  hydro-fluosilicic 
acid. 

Medical  Properties  and  Therapeutic  Uses. — Sodium  silico-fluo- 
ride,  in  the  form  of  a  white  powder,  is  antiseptic,  disinfectant 
and  styptic.  Experiments  with  this  salt  by  Mr.  Wm.  Thom- 
son, F.  B.  F.  C,  F.  C.  S.,  show  that  the  compounds  of  fluorine 
were  powerful  disinfectants,  and  of  these  the  sodium  silico-fluo- 
ride  was  the  most  serviceable.  It  has  been  employed  as  a  sub- 
stitute for  peroxide  of  hydrogen  on  account  of  the  changeable 
nature  of  the  latter  agent.  Even  in  a  saturated  solution,  sodium 
silico-fluoride  is  not  an  escharotic  coagulant,  but  it  is  a  slight  irri- 
tant in  such  a  form,  which  is  not  a  positive  disadvantage  in  the 
treatment  of  some  affections,  such  as  alveolar  pyorrhoea  for  ex- 
ample. 

Dental  Uses. — Sodium  silico-fluoride  has  been  used  with  good 
results  in  cases  of  putrescent  pulps,  chronic  alveolar  abscesses, 
pyorrhcEa  alveolaris.  Also  as  a  deodorizer  in  pulp  canals  by  de- 
stroying the  putrescent  hydrogen.  As  a  disinfectant,  it  is  power- 
ful enough,  even  in  weak  solution  to  antagonize,  in  a  marked  de- 
gree, the  germs  of  putrefaction ;  as  a  coagulant,  it  is  non-escha- 
rotic ;  as  a  deodorant,  it  is  strong  enough  to  destroy  the  most 
penetrating  of  putrefactive  odors;  as  a  stimulant,  it  is  powerful 
enough  in  full  solution  to  bring  about  the  formation  of  new  tissue, 
and  not  act  as  an  irritant  to  surrounding  tissue ;  it  is  compara- 
tively unchangeable.  Such  properties  may  render  it  one  of  the 
most  useful  salts  in  the  dental  pharmacopoeia. 

SOZOIODOL. 

Sozoiodol  contains  more  than  50  per  cent,  of  iodine,  and  is 
antiseptic  and  disinfectant,  and  is  a  much  better  prepared  combi- 
nation than  that  first  prepared  under  this  name.  It  is  employed 
in  the  form  of  a  five  per  cent,  watery  solution,  in  powder,  and 
also  in  a  form  known  as  zinc-sozoiodol  in  the  strength  of  a  two 
per  cent,  solution. 

Therapeutic    Uses. — Sozoiodol  is   valuable  as  an  antiseptic  and 


STROPANTHUS.  555 


disinfectant  in  the  treatment  of  unhealthy  wounds,  pharyngeal 
catarrh,  acute  purulent  conjunctivitis,  and  other  diseases  of  the 
eyes.  The  powder  has  been  successfully  used  in  catarrh  of  the 
cervix  uteri,  and  the  zinc-sozoiodol  in  urethritis,  and  vaginitis  ; 
also  in  eczema  and  impetigo. 

Dental  Uses. — Sozoiodol  is  employed  with  advantage  in  the 
acute  forms  of  stomatitis,  and  other  conditions  of  the  oral  mucous 
membrane,  also  in  unhealthy  or  contaminated  wounds  of  the 
mouth  in  the  forms  of  a  watery  solution  or  powder. 

STROPHANTHUS— STROPHANTHUS  HISPIDUS. 

Source. — Strophanthus  is  derived  from  the  climbing  plant  stro- 
phanthus  hispidus  (Apocynaceas)  of  western  Africa,  from  the  ex- 
tract of  which  the  arrow-poison  Kombe  is  made  by  the  natives. 
The  active  principle  is  Strophanthine  from  which  Strophanthidin  is 
derived  by  the  action  of  sulphuric  acid.  Strophanthin  is  a  crys- 
tallizable  glucoside,  common  to  different  parts  of  the  plant,  but 
especially  in  the  seeds  which  yield  a  large  proportion. 

Medical  Properties  and  Therapeutic  Uses. — Strophanthin  is  bit- 
ter, acidulous,  insoluble  in  ether  and  chloroform,  but  soluble  in 
alcohol  and  water.  It  is  a  local  anaesthetic,  as  three  or  four  drops 
of  a  solution  of  i  to  lOOO  dropped  into  the  cornea  will  anaesthe- 
tize it  for  one  or  two  hours  without  any  irritation  of  the  conjunc- 
tiva. It  is  considered  by  some  to  be  a  more  powerful  local 
anaesthetic  than  cocaine.  The  sensation  of  heat  and  cold  is  the 
last  to  be  overcome,  and  the  first  to  revive.  Strophanthus  is  a 
cardiac  tonic,  in  its  action  resembling  digitalis.  It  lessens  the 
heart's  action,  lengthens  the  intervals  between  the  contractions, 
and  increases  the  energy  of  the  muscular  tissue.  In  fatal  cases 
the  heart's  action  is  arrested  in  diastole.  It  may  be  used  to  fulfil 
the  same  indications  as  digitalis,  and  is  quicker  in  action  and  less 
protracted,  but  is  considered  to  be  less  certain.  It  is  less  irri- 
tating and  more  prompt  when  used  hypodermically  than  digitalis. 
It  is  a  very  powerful  drug.  It  is  also  to  some  degree  a  diuretic, 
and  the  prolonged  use  of  strophanthus  will  sometimes  cause  diar- 
rhoea.     Besides  its  employment  as  a  local  anaesthetic  it  is  admin- 


556  DENTAL  MEDICINE. 


istered  in  cardiac  dropsy,  as  a  cardiac  stimulant  in  typhoid  fever, 
also  in  angina  pectoris,  bronchial  asthma,  whooping-cough,  etc. 

Dose. — Of  the  tincture — tinctura  strophanthi  (5  per  cent.),  Til 
ij  to  X  ;  of  strophanthin,  gr.  i-iooo  to  1-60.  Strophanthin  may 
also  be  administered  hypodermically  in  doses  of  gr.  ij^r,  not  more 
than  once  daily. 

Dental  Uses. — Strophanthin  is  employed  in  dental  practice  as  a 
local  anaesthetic  and  obtunder  of  hypersensitive  dentine.  As  a 
local  anaesthetic  it  is  usually  combined  with  cocaine,  atropine, 
some  of  the  essential  oils  and  glycerine. 

DENTAL    FORMULA. 

For  Local  AttcEsthesia. 

Dr.  Birge. 

B .        Strophanthin gr.  ^ 

Sulphate  atropin g""  j 

Carbolic  acid  (95  per  cent,  sol.) gtts.v 

Hydrochlorate  of  cocaine grs.xx 

Distilled  water q.  s.  f ^j.  M. 

SiGNA. — Inject  4  to  6  drops  hypodermically. 

SULFONAL— SULPHONAL. 

Formula.— Q.,  H,,S  A=(CH3), :  C  :{^0,Q.^^,. 

Sulfonal  is  in  the  form  of  colorless  prisms,  odorless  and  taste- 
less. It  is  easily  soluble  in  hot  water  and  in  alcohol,  and  but 
slightly  soluble  in  100  parts  of  cold  water,  and  is  soluble  in  18  to 
20  parts  of  hot  water,  and  melts  at  258°  F. ;  it  is  also  soluble  in 
alcohol  and  ether ;  it  is  not  affected  by  any  of  the  ordinary  acids. 
It  appears  to  possess  hypnotic  properties  of  considerable  power, 
and  is  regarded  as  prompt  and  reliable,  producing  a  quiet,  natural 
sleep,  lasting  a  number  of  hours.  It  appears  to  have  no  unfavor- 
able effects  on  the  heart  or  the  circulation,  nor  on  the  tempera- 
ture, the  pulse  or  the  respiration,  and  to  produce  no  disagreeable 
secondary  symptoms,  nor  to  interfere  with  the  process  of  diges- 
tion. 

It  is  best  administered  in  hot  liquids,  such  as  a  bowl  of  soup  or 
broth,  a  cup  of  milk,  tea,  coffee,  cocoa,  in  capsules,  or  in  acacia 
mucilage,  etc. 


SULPHONAL.  557 


Medical  Properties  and  Physiological  Action. — The  conclusions 
drawn  by  Mathes  are  as  follows:  i.  Sulfonal  is  a  useful  hypnotic 
agent,  though  it  is  not  always  efficacious.  2.  It  has  the  advan- 
tage over  other  agents  of  having  no  odor  or  taste,  and  no  influ- 
ence on  the  essential  organs  of  life.  3.  The  worst  of  its 
disagreeable  effects  are  insignificant.  4.  The  dose  depends  upon 
the  individual  susceptibility,  and  is  therefore  variable.  Gener- 
ally a  gramme  is  sufficient  to  cause  sleep  without  accessory  mani- 
festations. When  these  are  produced  the  dose  should  be 
diminished.  On  account  of  its  slow  action,  it  should  be  given 
at  least  an  hour  before  the  time  for  sleep.  5.  When  the  in- 
somnia is  due  to  irritating  cough  or  to  pains  not  clearly  neuralgic, 
the  use  of  sulfonal  is  contra-indicated.  In  most  true  neuralgias, 
on  the  contrary,  it  may  be  used  with  benefit.  Sulphonal  should 
be  used  2  or  3  hours  before  the  patient  retires. 

It  is  a  valuable  remedy  for  persistent  neuralgia  in  doses  of  gr. 
x-xxx ;  it  may  be  administered  in  hot  liquids  such  as  tea,  in  the 
form  of  tablets  of  five  and  fifteen  grains. 

Dose. — Grs.  X  to  grs.  xxx  ;  but  variable,  depending  upon  the 
individual  susceptibility. 

Although  sulphonal  is  probably  one  of  the  safest,  as  it  is  one  of 
the  most  efficacious  among  the  recent  hypnotics,  the  series  of 
cases  published  by  Bresslaur,  of  Vienna,  show  clearly  that  it  has 
certain  dangers.  Out  of  seventy-seven  feeble  lunatic  patients 
who  were  treated  with  this  drug,  no  less  than  seven  showed  seri- 
ous symptoms,  and  in  five  of  these  there  was  a  fatal  termination  ; 
but  it  should  be  stated  that  the  patients  had  been  taking  the  drug 
for  a  considerable  time  in  good  doses,  and  had  borne  it  well  until 
symptoms  of  disturbance  appeared,  such  as  great  constipation, 
dark-brown  urine,  slow  but  in  some  cases  rapid  but  feeble  pulse, 
discolored  patches  resembling  purpura  on  the  limbs,  and  great 
prostration.  In  the  cases  which  ended  fatally,  the  cause  of  death 
was  heart-failure,  with  cedema  of  the  lungs.  A  number  of  fatal 
cases  of  acute  and  chronic  poisoning  from  sulphonal  are  recorded. 
Sulphonal  should  not  be  used  continuously  for  more  than  a  few 
days. 

Dental   Uses. — Dr.  Chase  recommends  sulphonal  very   highly 


558  DENTAL  MEDICINE. 

for  nervous  patients  after  a  protracted  dental  operation,  as  a  small 
dose  will  give  a  quiet  night's  rest. 

TERCHLORIDE  OF  PHENOL. 

Derivation. — Terchloride  of  Phenol  has  recently  been  intro- 
duced as  a  disinfectant  and  antiseptic.  It  is  prepared  by  passing 
a  stream  of  chlorine  gas  through  chemically  pure  carbolic  acid, 
previously  melted,  until  it  acquires  a  violet  hue.  When  carbolic 
acid  is  acted  upon  by  chlorine  gas  a  number  of  compounds  are 
produced ;  such  as  a  monochloride,  a  bichloride  and  a  tri-  or  ter- 
chloride of  carbolic  acid  (phenol). 

Medical  Properties  and  Action. — It  is  not  an  irritant,  and  has  no 
acid  reaction. 

Therapeutic  and  Dental  Uses.  —  Terchloride  of  phenol  is 
claimed  to  be  a  valuable  antiseptic  and  disinfectant  in  the  treat- 
ment of  gangrenous  ulcers,  etc.  In  dental  practice  it  has  been 
very  recently  recommended  in  combination  with  iodoform,  as  a 
material  for  capping  exposed  pulps  and  as  a  filling  for  root  canals 
of  teeth,  and  the  advantages  claimed  for  it  are,  that  it  will  be  re- 
absorbed when  in  contact  with  living  tissues ;  it  is  easily  intro- 
duced into  pulp  canals ;  it  absorbs  exudations ;  it  becomes  hard 
when  mixed  with  certain  chemical  substances,  but  is  destroyed 
by  pus ;  it  is  a  very  bad  conductor  of  heat ;  and  it  is  absolutely  a 
non-irritant.  The  method  recommended  for  its  use  as  a  capping 
and  filling  material  is,  to  incorporate  iodoform  and  terchloride  of 
phenol  with  decalcified  dead  bone,  as  follows :  dead  bone  or 
ivory,  shavings  are  decalcified  in  a  ten  per  cent,  solution  of 
chemically  pure  hydrochloric  acid,  and  after  all  the  lime  salts  are 
extracted,  the  residue  is  collected  upon  a  filter,  washed,  dried  and 
rubbed  to  a  fine  powder  in  a  porcelain  or  glass  mortar.  Upon 
this  powder  ten  times  its  weight  of  a  ten  per  cent,  solution  of 
iodoform  in  sulphuric  ether  is  gradually  poured  and  constantly 
rubbed  until  a  fine  yellow  powder  is  obtained,  which  contains 
about  fifty  per  cent,  of  iodoform.  When  used  as  a  capping  for 
pulps,  or  a  filling  material  for  root  canals  of  teeth,  this  powder  is 
made  into  a  paste  by  the  addition  of  carbolic  acid  or  terchloride 
of  phenol,  being  worked  or  rubbed  together  like  ordinary  cement. 


TURPENTINE.,  559 


For  hyperaemic  conditions  of  the  dental  pulp  success  has  at- 
tended the  application  of  a  cap  of  the  iodoform  and  decalcified 
bone  paste  mixed  with  terchloride  of  phenol.  For  inflamed 
pulps  the  application  of  terchloride  of  phenol  is  to  be  repeated 
every  third  or  fifth  day,  until  no  more  pain  is  felt,  and  the  pulp 
is  then  to  be  capped  with  the  decalcified  bone,  iodoform  and 
terchloride  of  phenol  material,  and  a  temporary  filling  introduced 
into  the  crown  cavity.  The  treatment  of  ulcerated  and  gan- 
grenous pulps  of  the  teeth  consists  in  treating  with  the  terchloride 
of  phenol,  and  after  the  second  or  third  application,  if  no  trouble 
occurs  from  a  temporary  closure  of  the  root  canals,  to  fill  with 
the  decalcified  bone,  iodoform  and  terchloride  material,  using 
whalebone  instruments  for  its  introduction,  until  congelation  is 
occasioned,  and  the  congested  condition  of  the  capillaries  of  the 
part  relieved,  acting  as  a  counter-irritant  and  antiphlogistic. 

TEREBINTHINA— TURPENTINE. 

Source. — The  concrete  oleo-resin  of  Pinus  australis  and  various 
species  of  pine. 

Oleum  Terebinthince. — Oil  of  Turpentine  obtained  by  distilla- 
tion. 

Formula. — CjoHjg. 

Oil  of  Turpentine  is  a  limpid,  volatile,  colorless  oil,  with  a  hot 
pungent  taste  and  a  strong  peculiar  odor.  It  is  slightly  soluble 
in  water.  In  small  doses  it  increases  the  action  of  the  heart, 
elevates  the  arterial  tension  and  causes  a  sense  of  warmth  and 
exhilaration. 

In  large  doses  it  causes  thirst,  fever,  vomiting,  weakness  and  a 
species  of  intoxication.  In  poisonous  doses  there  is  complete 
muscular  relaxation,  insensibility,  flushed  face,  dilated  pupils, 
labored  and  stertorous  breathing.  It  stimulates  the  vaso-motor 
system,  and  has  marked  antiseptic  properties,  arresting  fermenta- 
tion and  putrefaction,  and  destroying  micro-organisms.  Inhala-- 
tion  of  the  vapor  of  turpentine  causes  headache,  nasal  and 
bronchial  irritation,  ecchymosis  of  the  air-passages,  hyperaemia 
of  the  kidneys  and  congestion  of  the  lungs. 

The  ozonized   oil  of  turpentine  is  an  antidote  to  phosphorus, 


560  DENTAL  MEDICINE. 


by  the  power  it  possesses  of  converting  the  agent  into  an  in- 
soluble substance ;  and  a  vial  of  turpentine  worn  about  the  neck 
prevents  necrosis  of  the  jaw  and  steatosis  in  workmen  using 
phosphorus  in  manufactories. 

Sanitas  is  a  highly  ozonized  preparation  of  turpentine,  and  is 
used  as  an  antidote  to  phosphorus  poisoning.  (See  oil  of 
Sanitas.) 

Oil  of  turpentine  is  employed  in  flatulence,  colic,  chronic  in- 
testinal catarrh, constipation  and  as  an  anthelmintic;  also  in  passive 
hemorrhages  from  mucous  surfaces,  taenia  and  as  a  stimulant  in 
low  fevers.  In  the  form  of  enemata  for  colic,  tympanitic  dis- 
tension and  impaction  of  fasces,  etc. ;  in  the  form  of  liniment 
for  myalgia,  neuralgia,  lumbago,  etc. ;  also  for  burns,  erysipelas 
and  chilblains. 

Terehinthene. — (CipHig)  is  a  hydrocarbon  formed  by  the  distilla- 
tion of  turpentine  with  an  alkali.  Terehinthene  is  converted  by 
hydration  into  a  solid  crystalline  body,  known  as  terpine ;  and 
terpine  is  converted  into  terpinol  by  an  acid.  Terehene  is  derived 
from  turpentine  by  the  action  of  sulphuric  acid.  These  deriva- 
tions are  used  in  bronchitis,  broncho-pneumonia,  asthma,  etc. 
In  dental  practice  terpinol  is  employed  as  an  antiseptic,  disinfect- 
ant and  sterilizer. 

Dose. — Oil  of  turpentine,  TTtv  to  §ss;  of  terebinthene-ter- 
pine,  gr.  v  to  gr.  xx  ;  of  terpinol,  gr.  ij  to  gr.  v  ;  of  terebene, 
TTLv  to  XX. 

Linimentum  Terehinthina. — Liniment  of  Turpentine  is  com- 
posed of  oil  of  turpentine  thirty-five  parts  and  resin  cerate  sixty- 
five  parts. 

Oil  of  Sanitas — Oleum  Sanitas.,  is  obtained  by  the  oxidation  of 
oil  of  turpentine  floating  on  water,  by  directing  a  stream  of  heated 
air  on  its  surface.  Sanitas  oil  is  an  antiseptic  and  disinfectant^ 
possessing  considerable  oxydizing  power.  It  is  non-irritant  and 
non-poisonous,  and  its  odor  is  similar  to  that  of  fresh  pine.  The 
oils  of  cinnamon,  gaultheria  and  sassafras  will  disguise  its  odor. 
In  dental  practice,  the  oil  of  sanitas  has  been  very  successfully 
employed  in  alveolar  pyorrhoea,  alveolar  abscess,  diseases  of 
mucous  membrane,  exposed   pulps,  abscess  of  the  antrum,  foul 


THYMOL.  5gl 

ulcers,  wounds  and  ulcerated  sore  throat ;  also  as  a  protection 
against  phosphorus  poisoning  and  phosphor-necrosis  of  the  jaw. 

The  oil  of  turpentine  is  employed  as  a  styptic  in  dental  hem- 
orrhage, applied  on  cotton  after  the  loose  clot  is  removed,  and 
the  cavity  thoroughly  washed  out  with  hot  water.  For  hemor- 
rhage following  the  removal  of  single  root  teeth,  it  is  recom- 
mended to  wrap  the  root  of  the  extracted  tooth  with  a  few 
shreds  of  cotton  saturated  with  oil  of  turpentine  and  return  it  to 
its  cavity. 

Oil  of  turpentine  is  also  employed  as  a  sterilizer  of  surgical 
and  dental  instruments,  gauze,  bandages,  towels,  etc.  The 
method,  which  is  simple,  consists  in  placing  the  oil  of  turpentine 
in  flat,  large-mouthed  bottles  at  the  bottom  of  each  case  or 
drawer,  the  volatility  of  the  agent  causing  the  vapor  to  impreg- 
nate the  surrounding  air. 

Sanitol. — A  new  preparation  in  which  are  embodied  formol 
and  salitrol,  coal-tar  derivatives.  It  is  non-irritating  and  possesses 
antiseptic  properties.  It  is  recommended  as  a  dentifrice  which 
is  said  to  contain  no  soap,  acid  or  alkali. 

The  formula  is  Salitrol,  Formol,  Boracic  acid,  Plantago  ma- 
jorum.  Menthol  and  Spirits  of  Cologne.  It  is  claimed  to  be  a 
pleasant  antiseptic  dentifrice. 

For  Dental  Hemorrhages  from  Constitutional  Vice, 
Mr.  Salter. 

U.       Vitelli  ov Tij 

Olei  terebinth Tjss 

Tinct.  ferri  ses  chloride ziij 

Sacchari zij 

Aquae      ^viij.       M. 

Dose :  A  teaspoonful  every  hour. 

THYMOL. 

Formula.— Q,^Y{,lO^). 

Derivation. — Thymol,  or  thymic  acid,  is  obtained  from  the 
herb  thymus  vulgaris.,  or  common  thyme,  which  is  cultivated  in 
this  country  for  the  same  purpose  as  sage,  lavender,  etc.  Thyme 
36 


562  DENTAL  MEDICINE. 


yields  a  volatile  oil,  oleum  thymi^  from  which  thymol  or  thymic 
acid  is  obtained  by  treating  the  oil  with  an  aqueous  solution  of 
potassa  or  soda,  which  separates  it  from  a  principle  called  thymene^ 
with  which  it  is  mixed  in  the  oil,  and  which  is  not  affected  by 
the  alkalies.  The  thymate  thus  formed  is  decomposed  by  an 
acid,  and  the  liberated  thymol,  or  thymic  acid,  is  purified  by 
repeated  washings,  dessication  and  distillation.  Thymol  is  in  the 
form  of  aromatic  white  crystals,  soluble  in  one  thousand  parts  of 
hot  water. 

Medical  Properties  and  Action. — In  a  concentrated  state,  thymol 
has  an  acrid  and  caustic  taste  ;  but  when  very  much  diluted,  the 
only  taste  experienced  is  that  of  thyme. 

Thymol  has  acrid  properties,  and  is  similar  in  its  action  to 
carbolic  acid.  It  imparts  a  sense  of  coolness  to  the  mouth,  like 
that  of  oil  of  peppermint,  and  when  once  melted  it  remains 
indefinitely  in  the  liquid  state. 

While  it  is  only  slightly  soluble  in  water,  it  is  freely  soluble 
in  alcohol,  and  is  dissolved  by  ether  and  the  fixed  oils.  The 
alkalies  unite  with  it  to  form  soluble  salts.  Like  creasote,  it  has 
the  property  of  combining  with  animal  tissues,  and  thus  prevents 
putrefaction.  While  it  has  the  important  practical  properties  of 
carbolic  acid,  it  is  free  from  disagreeable  odor,  and  it  is  claimed 
to  be  as  efficient  an  antiseptic  as  that  agent. 

Therapeutic  Uses. — Thymol  is  almost  exclusively  employed  as 
an  external  application,  and  is  often  substituted  for  the  oil  of 
origanum,  which  is  obtained  from  the  common  marjoram.  It 
is  considered  to  be  a  valuable  antiseptic  and  antifermentative 
agent. 

Dental  Uses. — Thymol,  when  combined  with  glycerine,  in  a 
form  known  as  Glycerole  of  Thymol.,  is  a  valuable  antiseptic  in  the 
treatment  of  suppurating  pulps  of  teeth,  as  a  dressing  for  ulcers 
of  the  mouth,  wounds,  etc.;  also  in  the  treatment  of  teeth  after 
the  devitalization  of  the  pulp,  chronic  inflammation  of  the  pulp, 
and  alveolar  abscess,  as  it  arrests  the  putrefactive  process;  also 
in  stomatitis  and  abrasion  of  mucous  membrane.  Hartmann  rec- 
ommends sprinkling  crystallized  thymol  on  an  exposed  (not  bleed- 
ing pulp),  to  relieve  the  pain  of  pulpitis. 


THYMOL. 


563 


ptm.j 
ptm.j 
ptm.j. 
pts.  V  to  XV. 


DENTAL 

Glycerole  of  Thymol. 
R .    Thymoli  (cryst.)     .    .  gr.xx 
Glycerini, 

Alcoholis    .    .    .    .  aa  f  Jj 
Aquae  destillatae  .    .    .  Oj.  M 

For  Alveolar  Abscess,    Suppurating 
Pulps,  etc. 
Alvin. 
R.    Thymoli  (cryst.) 

lodi 

Potassii  iodidi  .    . 
Glycerini  .... 
SiGNA. — Apply  as  in  use  of  carbolic 
acid. 

For  Stomatitis. 
Alvin. 
R.    Thymoli  (cryst.)     .    .ptm.j 

Glycerini pts.  lOO. 

SiGNA. — To   be   used  as  a  lotion  and 

gargle. 
For   an    Antiseptic   in    Suppurating 
Pulps,  Alveolar  Abscess,  etc. 
R.    Thymoli  (cryst.)     .    .  ptm.i 

Glycerini pts.  ij  to  iv. 

SiGNA. — Applied  in  the  same  manner 
as  carbolic  acid. 

Antiseptic  and  Germicide  Mouth 

Wash. 

\V.  D.  Miller. 

R.    Thymoli grs.iv 

Acidi  benzoici     .    .    .   grs.45 

Eucalyptol 33^ 

Alcoholis 525 

Olei  gaultherise    .    .    .  gtt.25.    M. 

An  Antiseptic  Gargle. 

R.    Thymoli yA  grs. 

Acidi  benzoici       .    .    45  grs. 
Tinct.  of  eucalypti   .  180  grs. 

AquDe Oij.    M. 

SiGNA. — After  cleansing  the  teeth,  use 
as  a  gargle  for  half  a  minute  or  a 
minute. 


FORMUL.ffi. 

Antiseptic  Fluid. 

VOLKMANN. 

R .  Thymoli  ....  I  part 
Alcoholis  ....  10  parts 
Glycerini  .  20  parts 
Aquae 1 00  parts.    M. 

SiGNA. — Apply  as  a  lotion. 


For  Stofnatitis. 

David. 

R .    Thymoli gr.vij 

Boracis gr-xv 

Aquae ^iss.      M, 

SiGNA. — Use  as  a  tonic  and  antiseptic 
mouth  wash,  by  placing  a  few  drops 
in  a  wine  glass  of  warm  water. 


For  Fetid  Breath  from  Deposits  about 
Tonsils  and  Gums. 

David. 

R .    Sodii  Boracis  ....   gr.xv 

Alcoholis Tss 

Thymoli gr-vij 

Aquae Oj.         M. 

SiGNA. — Use  as  a  mouth  wash. 


Antiseptic  Mouth  Wash, 
Dr.  W.  D.  Miller. 

R .    Thymoli gr.ij 

Acidi  benzoici     .    .    .   gr.xivj 
Hydrarg.  bichlor,    .    .  gr.ix 
Tinct.  eucalypti  .    .    .  ^ss 
Olei  peppermint     .    .   gr.xj 

Alcoholis ^xxvj.  M. 

Filter  and  add  sufficient  of  the  solu- 
tion to  a  wine  glass  of  water. 
SiGNA. — Rinse  with  this  mixture  twice 
sufficiently  to  sterilize  mouth. 


564  DENTAL  MEDICINE. 


For  a  Nerve  Paste.  of  the  above,  apply  at  once  without 

Dr.  S.  H.  McNaughton.  washing  out  the  cavity  : 

R.    Thymoli gr.xxiv  R.    Camphorae        ....  gr.6o 

Camphone gr.xij  Acidi  tannici    ....  gr.30 

Acidum  arseniosum    .   gr.iij.     M.  Alcoholis ^j.         M. 

If  much  pain  follows  the  application 

Glyco-  Thymoline.  —  Kress.  —  Contains  Thymoline,  Sodium, 
Boracic  acid,  Benzoin,  Salicylic  acid,  Eucalyptol,  Betula  Senta, 
Menthol,  Pini  Pumillionis.  It  is  alkaline,  antiseptic  deodor- 
izing. 

Thymacetin  bears  the  same  relation  to  thymol  as  phenacetine 
to  phenol.  It  is  a  white,  crystalline  powder,  slightly  soluble  in 
water.  Excessive  doses  cause  symptoms  of  intoxication.  Jolly 
asserts  that  in  certain  forms  of  headache  it  proves  equal  to 
phenacetine.  It  induces  sleep  in  cases  of  insomnia.  The 
average  dose  is  grs.  viiss. 

TRICHLORACETIC  ACID— ACIDUM  TRICHLORACETICUM. 

Formula. — CgHCIgOg. 

Derivation. — Trichloracetic  acid  is  prepared  by  the  oxidation 
of  hydrate  of  chloral  by  means  of  nitric  acid.  It  consists  of 
colorless,  rhombic  deliquescent  crystals.  It  belongs  to  a  group 
of  three  acids,  the  other  two  being  the  monochloracetic  and  the 
dichloracetic  acids,  and  the  difference  in  their  composition  is  due 
to  the  proportions  of  chlorine  they  contain.  They  have  similar 
properties. 

Medical  Properties  and  Action. — Trichloracetic  acid  in  its  full 
strength  is  a  very  powerful  escharotic  and  styptic.  It  is  readily 
soluble  in  water  and  alcohol,  with  an  agreeable  odor.  It  coagu- 
lates albumen,  and  its  concentrated  solutions  are  powerfully 
caustic.  Diluted  solutions  cause  an  increased  secretion  of  saliva, 
and  destroy  its  power  to  convert  starch  into  sugar ;  it  also  arrests 
the  digestive  action  of  pepsin.  As  an  antiseptic  it  has  been 
employed  in  putrid  and  indolent  wounds,  in  the  form  of  weak 
solutions,  which  are  unirritating,  and  promotes  healthy  granu- 
lations and  cicatrization  ;  it  has  also  been  employed  externallv  in 
erysipelas  and  venereal   sores.      Internally,  it  has  been  recom- 


TRICHLORACETIC  ACID.  565 

mended  by  Dr.  Filippowitch  as  a  preventive  of  cholera,  in  doses 
of  gr.  ij  to  iij,  three  or  four  times  daily.  Externally,  it  is  em- 
ployed in  one  or  two  per  cent,  solutions.  The  common  dose  is 
gr.  ij  to  V,  in  very  dilute  solutions,  three  times  a  day. 

Therapeutic  Usesi — Trichloracetic  acid  is  stimulant,  refriger- 
ant, antiseptic,  escharotic  and  styptic,  and  a  solvent  of  calculi. 
It  is  also  a  powerful  caustic  and  escharotic  ;  diluted  with  water 
to  a  strength  of  three  per  cent,  it  is  an  efficient  astringent  and 
stimulant,  and  diluted  to  a  strength  of  one  per  cent,  it  is  useful 
as  a  refrigerant  mouth  wash.  It  coagulates  albumen,  and  its 
concentrated  solutions  are  caustic.  Diluted  solutions  cause  an 
increased  secretion  of  saliva,  and  destroy  its  power  to  convert 
starch  into  sugar;  it  also  arrests  the  digestive  action  of  pepsin. 
It  is  employed  as  an  antiseptic  in  the  treatment  of  putrid  and 
indolent  wounds,  in  the  form  of  weak,  unirritating  solutions,  and 
promotes  healthy  granulations  and  cicatrization  ;  it  has  also  been 
employed  externally  in  erysipelas  and  on  venereal  sores.  Ex- 
ternally, it  is  generally  employed  in  one  or  two  per  cent,  solu- 
tions. It  destroys  all  forms  of  organic  life  in  such  a  percentage  ; 
and  in  five  per  cent,  solution  it  arrests  the  growth  of  bacteria 
and  other  forms  of  micro-organisms.  Internally,  it  has  been 
administered  in  cholera,  gastric  catarrh,  etc.,  in  doses  of  grains  ij 
to  iij  :  for  summer  complaint  of  children,  the  dose  is  5^  to  i 
grain,  3  times  daily. 

Dental  Uses. — Trichloracetic  acid  is  employed  in  dental  prac- 
tice as  an  escharotic  in  the  treatment  of  pyorrhoea  alveolaris,  on 
account  of  its  destructive  effect  on  pus  secreting  surfaces  of  the 
alveoli  of  teeth,  for  which  purpose  a  ten  per  cent,  solution  is  ap- 
plied. It  is  also  employed  for  the  removal  of  vascular  tumors  of 
the  pulp,  and  hypertrophy  of  the  margins  of  the  gums,  and 
epulis.  It  destroys  hypertrophied  gum  tissue,  and  when  such 
tissue  has  grown  into  and  filled  up  carious  cavities  in  teeth,  and 
been  cut  away,  and  the  profuse  hemorrhage  interferes  with  the 
filling,  an  application  of  trichloracetic  acid  will  not  only  remove 
such  tissue,  but  arrests  the  hemorrhage  in  a  few  minutes. 

Dr.  Kirk  speaks  of  using  this  acid  in  the  strong  solution  of 
about  ninety  per  cent,  for  the  removal  of  such  growths.     Tri- 


566  DENTAL  MEDICINE. 


chloracetic  acid  has  also  a  solvent  effect  on  calculi  upon  the 
roots  of  teeth  and  on  necrosed  bone,  a  ten  per  cent,  solution  in 
water  being  recommended,  and  has  also  been  employed  on  the 
overhanging  and  resistant  gum  of  third  molars.  One  application 
to  the  pus-pockets  of  alveolar  pyorrhoea,  will  cleanse  the  surface 
of  the  alveolus  and  the  diseased  tissue  lining  the  pocket,  and 
remove  any  calculi  present ;  any  subsequent  applications  should 
be  not  stronger  than  four  per  cent,  solutions.  When  used  in 
full  strength,  it  should  be  followed  with  bicarbonate  of  soda  to 
counteract  the  effect.  A  one  per  cent,  solution  has  been  success- 
fully employed  as  a  mouth  wash,  for  its  astringent  and  stimulat- 
ing action  in  inflammations  and  ulcerations.  It  is  also  used  in 
combination  with  pyrozone  in  the  treatment  of  alveolar  pyor- 
rhoea, and  in  such  a  solution,  as  well  as  alone,  its  effects  have 
been  remarkably  satisfactory.  Trichloracetic  acid  may  be  com- 
bined with  any  suitable  alkaline  solution,  such  as  soda  or  mag- 
nesia, when  it  is  desirable  to  limit  its  action.  It  has  a  peculiar 
power  to  soften  and  remove  sanguinary  deposits,  and  it  acts 
without  injury  to  the  teeth  or  soft  tissues. 

Diluted  with  water  to  a  three  per  cent,  solution  it  is  an  excel- 
lent local  astringent  and  stimulant.  Dr.  Harlan  recommends  it 
for  removing  the  overlying  gum  for  third  molars,  as  it  destroys 
the  tissue  without  hemorrhage  or  subsequent  soreness.  Tri- 
chloracetic acid  is  also  employed  to  gain  access  to  roots  of 
abscessed  teeth  through  a  fistulous  opening,  one  crystal  followed 
by  more  being  placed  in  the  fistula  ;  it  is  also  used  for  removing 
gum  polypi,  in  necrosis  of  the  bones  of  the  jaws,  and  for  hyper- 
trophied  gums. 

TROPACOCAINE— BENZOYL-PSEUDO-TROPEIN. 

Derivation. — Tropacocaine  is  an  alkaloid  obtained  from  the 
leaves  of  a  plant  of  the  coca  family,  indigenous  to  Java,  and  has 
been  isolated  by  Giesel.  The  hydrochlorate  of  tropacocaine 
was  prepared  by  Lieberman,  as  the  base  of  the  product  he  ob- 
tained synthetically,  which  was  not  very  soluble  in  water.  Un- 
like cocaine  solution,  which  deteriorates  in  a  few  days,  the  solu- 
tion of  the  salt  tropacocaine  can   be  kept    for  several   months 


TROPACOCAINE.  5(57 


without  decomposition.  Tropacocaine,  by  its  chemical  com- 
position, belongs  to  the  atropine  group. 

Physiological  and  Therapeutic  Action. — Tropacocaine  is  a  local 
anaesthetic,  and  as  indicated  by  a  series  of  experiments  made  by 
Chadbourne,  is  about  half  as  toxic  as  cocaine,  and  possesses  the 
same  local  anaesthetic  properties  without  the  accidents  of  the 
latter  agent. 

No  symptoms  indicating  the  physiological  action  of  tropaco- 
caine followed  its  administration  internally  in  the  case  of  a  dose 
varying  from  one-third  to  three-quarters  of  a  grain ;  and  a  sub- 
mucous injection  of  nearly  one-half  grain  in  ten  drops  of  water 
in  many  nervous  and  frightened  persons,  produced  only  a  slight 
increase  in  the  number  of  radial  pulsations,  without  any  changes 
in  the  arterial  pressure.  No  bad  symptoms  apparently  followed 
the  hypodermic  injection  of  three-quarters  to  one  grain  of  tro- 
pacocaine even  in  nervous,  anaemic  and  tuberculous  patients,  ac- 
cording to  Pinet  and  Vian,  although  they  observed,  contrary  to 
what  occurs  in  cocaine,  an  increased  activity  in  the  peripheral 
circulation,  the  face  exhibiting  a  characteristic  rosy  hue,  and  the 
extremities  becoming  warm.  Their  conclusion  was  that  tropa- 
cocaine hydrochlorate  possesses  local  anaesthetic  properties  anala- 
gous  to  cocaine.  It  is  also  claimed  that  the  more  concentrated 
the  solution  of  this  drug,  the  more  rapid  is  its  action.  Its  effect 
upon  the  nervous  svstem,  as  well  as  upon  the  respiration,  is 
directly  opposite  to  what  occurs  in  the  intoxication  by  cocaine, 
as  an  equal  part  of  cocaine  has  produced  dangerous  symptoms, 
and,  on  the  contrary,  neither  respiration  nor  the  nervous  system 
appears  to  be  influenced  by  doses  of  three-quarters  of  a  grain  of 
tropacocaine.  And  although  its  use  may  not  be  without  danger, 
yet  it  is  undoubtedly  much  less  toxic  than  cocaine.  But  from 
the  fact  that  its  toxic  action  on  the  heart  is  very  rapid  when  such 
does  occur  (although  it  lasts  but  ten  minutes,  while  that  from 
cocaine  may  last  for  hours),  yet  the  use  of  tropacocaine  requires 
caution.  Prof.  H.  C.  Wood  states  that  this  drug  appears  to  have 
only  a  comparatively  feeble  influence  upon  the  circulation,  caus- 
ing, however,  when  in  sufficient  amount,  a  steady  fall  in  the 
arterial   pressure.     When   applied   to   the  eye,  the   anaesthesia  is 


568  DENTAL  MEDICINE. 


more  prompt,  and  disappears  more  quickly  than  with  cocaine, 
sensation  being  suspended  in  less  than  half  a  minute  after  the 
application  of  a  three  per  cent,  solution.  Dr.  Hugenschmidt 
claims  that  the  advantages  of  tropacocaine  over  cocaine  are : 

1.  Used  in  equal  doses  sufficient  to  produce  local  anaesthesia, 
the  new  drug  is  much  less  toxic  than  cocaine,  and  has  a  very 
slight  action  on  the  vital  functions  of  the  economy. 

2.  It  produces  a  local  anaesthesia  more  rapid  and  more  pro- 
nounced than  cocaine,  and  of  at  least  as  great  a  duration. 

3.  The  solution  of  the  salt  being  an  antiseptic,  as  was  pointed 
out  by  Chadbourne,  can  be  kept  for  several  months  without  de- 
terioration, while,  after  a  few  days,  a  cocaine  solution  is  worth- 
less for  injections. 

Dental  Uses. — Tropacocaine  is  employed  in  dental  practice  as 
a  local  anaesthetic  for  the  extraction  of  teeth,  for  the  perfora- 
tion of  the  alveolus,  removing  sequestrum,  sensitive  dentine, 
opening  of  abscesses,  etc.  Dr.  Hugenschmidt  regards  two- 
thirds  of  one  grain  in  fifteen  drops  of  water  as  sufficient  in  ordi- 
nary cases.  For  difficult  extractions,  four-fifths  of  one  grain,  he 
asserts,  will  produce  complete  anaesthesia.  The  injections  are 
made  as  with  cocaine,  but  not  suddenly,  as  at  least  one  minute 
should  be  emploved  in  injecting  the  dose,  which,  according  to 
Dr.  Hugenschmidt,  is  ten  drops  of  the  following  solution : 
Tropacocaine  hydrochlorate,  2  grains ;  distilled  water,  50  drops. 
M.  S. — Gtt.  X  for  one  local  anaesthesia.  The  tooth  or  root  to 
be  extracted,  or  region  to  be  operated  on,  is  surrounded  by  a 
series  of  injections  of  one  or  two  drops  of  the  above  solution 
until  ten  drops  have  been  injected.  The  dose  of  tropacocaine  is 
gr.  i  to  f.  Before  injection  the  mouth  should  be  made  aseptic 
by  washing  it  repeatedly  with  3  per  cent,  solution  of  pyrozone, 
10  per  cent,  solution  of  electrozone,  or  3  per  cent,  solution  of 
formaldehyde.  The  syringe  should  also  be  rendered  aseptic  by  a 
25  per  cent,  solution  of  phenol  sodique,  which  will  not  injure  the 
metallic  parts.  Care  should  be  taken  to  confine  the  injections 
to  the  gum  tissue,  as  serious  emphysema  may  result  from  injec- 
tions into  the  submucous  tissue  beneath  the  junction  of  the 
cheek  and  gum. 


URETHANE.  509 


URETHAN— URETHANE. 

Formula.— C.,H,1<!0.,=C,U,0C0'NH,. 

Derivation. — Urethan  is  a  combination  of  carbonic  acid  and 
ethylic  ether.  It  occurs  in  white  crystals,  without  odor,  taste- 
less, and  insoluble  in  water. 

Medical  Properties  and  Therapeutic  Uses. — Urethan  is  a  hyp- 
notic which  may  be  employed  to  cause  quiet  and  sleep  when  the 
conditions  are  favorable  to  its  action.  It  is  similar  to  paraldehyde 
and  has  no  irritating  effect  upon  the  stomach,  nor  does  it  impair 
digestion.  Although  insoluble  in  water,  the  fluids  of  the  stomach 
dissolve  it  readily,  and  it  promptly  diffuses  into  the  blood.  The 
first  effect  of  its  action  is  stimulating,  which  is  of  brief  duration, 
then  a  diminution  of  action,  slowing  of  circulation  and  respira- 
tion, decline  of  temperature  and  weakening  of  the  reflexes  which 
finally  disappear,  then  drowsiness  and  tranquil  sleep,  and,  if  the 
quantity  given  be  toxic,  coma  and  insensibility.  Fifteen  and 
one-half  grains  are  held  sufficient  to  cause  sleep.  It  is  not  an 
analgesic,  hence  pain  will  prevent  its  hypnotic  action.  Un- 
pleasant after-effects  do  not  occur,  except  when  stomachal 
troubles  are  present,  and  it  is  seldom  that  there  is  headache, 
nausea  or  vertigo.  Sleep  is  produced  in  fifteen  minutes  to  an 
hour,  and  continues  from  six  to  eight  hours.  It  has  been  em- 
ployed with  benefit  in  epilepsy,  chorea,  spasms,  cramp,  delirium 
tremens,  tetanus,  etc.     Its  action  upon  digestion  is  as  follows  : 

a.  Strong  solutions — that  is,  0.5  gramme,  0.25  gramme,  0.175 
gramme — delayed  digestion;  that  the  stronger  the  solution  the 
greater  was  the  delay. 

b.  Weak  solutions — that  is,  i,  2  and  3  milligrammes — neither 
delayed  nor  accelerated  digestion. 

c.  Neither  strong  nor  weak  solutions  retarded  decomposition. 

VASELIN— VASELINE. 
PETROLEUM    OINTMENT PETROLATUM,  COSMOLINE. 

Derivation. — Vaseline  is  obtained  from  crude  petroleum,  in  the 
from  of  a  petroleum  jelly.  In  the  distillation  of  crude  petroleum 
there   remains   in   the  apparatus,  after  the  separation  of  the  light 


570  DENTAL  MEDICINE. 


oils,  a  semi-liquid  tar,  which  constitutes  crude  vaseline,  which, 
in  such  a  state,  has  a  disagreeable  odor  like  petroleum,  of  a 
strong  taste  and  black  color.  This  compound  is  heated  in  the 
open  air,  and  decolorized  by  animal  charcoal,  the  product  being 
the  petroleum  jelly  known  as  vaseline,  which  is  a  mixture  of 
several  hydrocarbons. 

When  pure,  vaseline  is  white,  inodorus  and  insipid,  and  of  the 
consistence  of  jelly,  or  very  unctuous  fat.  It  melts  at  35°  C, 
boils  at  150°  C,  and  distills  at  200°  C,  and  burns  without  resi- 
due. Exposed  for  a  considerable  time  to  light,  it  acquires  a 
slight  odor  of  petroleum.  It  is  insoluble  in  water,  sparingly 
soluble  in  alcohol,  and  very  soluble  in  warm  ether,  chloroform, 
fats,  volatile  oils,  and  sulphide  of  carbon.  It  sensibly  dissolves 
iodine,  bromine,  sulphur,  phosphorus,  carbolic  acid,  benzoic  acid, 
atropine  and  strychnine. 

Medical  Properties  and  Action. — By  its  composition,  vaseline  is 
not  capable  of  becoming  rancid,  nor  of  being  saponified;  hence 
it  is  a  very  useful  agent  or  excipient  for  caustic  alkalies,  oxides, 
metallic  salts,  and  even  acids  in  the  cold  without  action  by  them, 
and  without  modifying  their  therapeutic  properties.  Incorporated 
in  ointments,  a  certain  quantity  of  vaseline  will  preserve  them 
and  obviate  rancidity,  being  preferable  to  lard,  butter,  glycerine 
and  glyceroles.  The  addition  of  paraffin  will  give  it  any  con- 
sistency desired. 

Therapeutic  Uses. — Vaseline  is  used  externally  as  a  dressing  for 
wounds,  cuts,  bruises,  sprains,  piles,  rheumatism,  skin  diseases, 
eczema,  inflamed  surfaces,  diseases  of  the  eye,  etc.,  etc.  Com- 
bined with  carbolic  acid,  it  forms  a  very  useful  ointment  for 
affections  of  the  skin,  putrescent  pulps  of  teeth,  etc.,  etc.,  under 
the  name  of  carhoU%ed  cosmoline. 

Dental  Uses. — Vaseline  is  an  efficacious  application  to  inflamed 
and  excoriated  surfaces  of  the  gums  and  mucous  membrane  of 
the  mouth ;  also  as  a  dressing  introduced  into  the  canals  of  teeth 
affected  with  periodontitis,  and  as  an  emollient  application  after 
the  devitalization  and  removal  of  dental  pulps.  Carbolated  cos- 
moline on  cotton  has  been  employed  for  filling  root  canals,  but 
the  results  have  not  in  all  cases  been  satisfactory. 


VERATRINE.  571 


In  the  form  of  Vaseline  Camphor  Ice^  it  is  a  pleasant  and  effica- 
cious application  to  chapped  lips  and  hands,  being  bland  and  non- 
irritating  in  its  action. 

An  ointment  made  by  dissolving  and  incorporating  thoroughly 
by  the  aid  of  heat,  equal  parts  of  vaseline  and  lead  plaster  to 
which  a  little  bergamot  may  be  added  for  perfume,  is  very  serv- 
iceable for  the  treatment  of  excoriated  surfaces,  and  dry  desqua- 
mating surfaces  of  certain  skin  diseases,  and  especially  the  form 
of  skin  affection  which  may  result  from  the  constant  use  of 
scented  soaps  on  the  hands. 


DENTAL   FORMULA. 

Local  Ancesthetic. 

Dr.  Poinsot. 

Jl,         Oleo-naphthine  (liquid  vaseline), 

Arachis  oil  .    .    . aa  50  centigrammes. 

Pure  cocaine 5  centigrammes. 

M. — Dissolve  the  cocaine  in  a  hot  water  bath  and  wash  gum 
where  the  injection  is  to  be  made  with  absolute  alcohol.  S. — Make 
a  number  of  injections  around  tooth  slowly,  and  wait  8  minutes. 

Vaselone. — Vaselone  is  a  substitute  for  vaseline  and  consists  of 
a  solution  of  stearone  and  margarone  in  neutral  mineral  oil. 
Stearone  is  prepared  by  distilling  stearine  with  lime.  Margarone 
is  prepared  in  a  similar  way,  from  beef  suet.  Vaselone  consists 
of  15  parts  of  margarone  and  5  of  stearone,  in  100  of  thoroughly 
purified  and  odorless  mineral  oil.  The  fatty  product  obtained, 
after  cooling,  resembles  vaseline,  but  is  not  as  transparent.  It  is 
white,  odorless,  neutral,  and  not  affected  by  acids  and  chemical 
reagents. 

VERATRINA— VERATRINE. 

Source. — Veratrine  is  an  alkaloid,  or  a  mixture  of  alkaloids,  ob- 
tained from  the  seeds  of  Asagraa  officinalis.,  of  the  natural  order 
Melanthacea.  It  is  in  the  form  of  a  white,  or  grayish-white 
amorphous  powder,  of  an  acrid  taste,  imparting  a  sensation  of  ting- 


572  DENTAL  MEDICINE. 


ling  and  numbness  to  the  tongue,  and  causing  constriction  of  the 
fauces  and  violent  sneezing.  It  is  but  slightly  soluble  in  cold  or 
hot  water,  to  which  it  imparts  an  acrid  taste  and  a  somewhat  al- 
kaline reaction. 

It  is  soluble  in  three  parts  of  alcohol  at  59°  F.,  and  very  solu- 
ble in  boiling  alcohol ;  also  soluble  in  6  parts  of  ether,  in  2  parts 
of  chloroform,  and  in  96  parts  of  glycerin;  it  melts  when  heated. 

Veratrine  Ointment — Unguentum  Veratrina — is  composed 
of  veratrine,  4  parts ;  alcohol,  6  parts ;  benzoinated  lard,  96 
parts.  The  veratrine  is  rubbed  with  the  alcohol  in  a  warm  mor- 
tar until  dissolved,  and  the  benzoinated  lard  gradually  added  and 
thoroughly  mixed. 

Therapeutic  Uses. — Veratrine  is  only  used  externally  in  neu- 
ralgia, myalgia,  headache,  rheumatism,  paralysis,  etc.,  in  the  form 
of  the  ointment,  or  dissolved  in  alcohol. 

Dental  Uses. — Veratrine,  in  the  form  of  the  ointment,  is  used 
for  facial  and  other  forms  of  neuralgia,  a  small  quantity  being 
rubbed  over  the  seat  of  pain.  It  is  also  used  as  an  obtundent  of 
sensitive  dentine. 


DENTAL   FORMUL.ffi. 

For  Sensitive  Dentine.  j,^  p^^-^i  j^euralgia. 

Dr.  Bogue.  _.      „ 

Dr.  Garretson. 

R .    Veratringe gr-  iv 

Acidum  tannicum     .    .  gr.j  R'    Veratrine gr.iv 

Alcoholis gttxx  Aconito gr.ij 

Glycerini f^j  Olei  tiglii gtt.ij 

Acidi  carbolici  .    .    .    .  ^ij.      M.  Olei  oliva; gij.       M. 

SiGNA. — Dry  the  tooth  thoroughly  and  Signa. — Rub  over  affected  part  thrice 
apply  to  sensitive  surface.  daily. 


VERATRUM  VIRIDE— AMERICAN  HEJ.LEBORE. 
POKE    ROOT. 

Source. — Veratrum  Viride,  of  the  natural  order  Melanthacea.,  the 
officinal  portion  of  which  is  the  root,  is  indigenous  to  the  swampy 
portions   of  the    United   States,  and   is   prepared   in  the  form  of 


VERATRUM  VIRIDE.  573 


slices  or  fragments,  of  a  dark  or  blackish-gray  color  externally, 
and  of  a  grayish-white  color  internally.  Its  odor  is  peculiar,  es- 
pecially when  it  is  moistened,  and  its  taste  is  bitter  and  acrid.  It 
is  inodorous,  but  in  the  form  of  powder  is  sternutatory.  It  is 
similar  in  chemical  composition  to  veratrum  album — white 
hellebore  and  veratrum  sabadillae.  Like  veratrum  album,  it 
contains  a  quantity  of  soft  resin,  and  two  alkaloids — -jervia  and 
veratroidia. 

Medical  Properties  and  Jction. — Veratrum  viride  is  acrid  and 
sedative,  causing  redness  and  heat  when  applied  to  the  skin,  and 
has  a  violent  sternutatory  effect  on  the  Schneiderian  membrane. 
Small  doses  stimulate  the  secretions  and  depress  the  pulse.  Al- 
though a  prompt  emetic,  its  operation  is  attended  with  intense 
nausea  and  depression,  and,  violent,  persistent  vomiting.  Large 
doses  occasion  great  depression,  with  a  weak  action  of  the  heart 
and  pulse,  vomiting,  retching,  cold  surface  of  body,  a  cold  per- 
spiration, faintness,  dimness  of  sight,  dilatation  of  the  pupils,  great 
muscular  weakness,  slow  respiration,  and  sometimes  coma,  in- 
sensibility and  stertorous  breathing,  but  notwithstanding  such 
symptoms,  fatal  results  are  rare.  The  antidotes  are  free  stimu- 
lants. The  tincture — Tinctura  Veratri  Firidis — is  the  best 
preparation  for  internal  administration. 

Therapeutic  Uses. — Veratrum  viride  is  not  employed  for  its 
emetic  effect  on  account  of  its  violent  action.  Internally  it  is 
administered  in  diseases  of  the  heart,  active  hemorrhage  in  the 
plethoric,  to  reduce  the  temperature  and  pulse  in  typhoid  and 
other  fevers,  in  acute  mania  and  delirium,  in  puerperal  convul- 
sions, neuralgia,  neuralgic  headache,  etc.  Externally  it  is  em- 
ployed for  neuralgia,  myalgia,  headache,  rheumatism,  paralysis, 
etc. 

Dose. — Of  the  tincture  of  veratrum  viride,  TTLi  to  TTtv;  of  the 
fluid  extract  of  veratrum  viride — Extractum  Veratri  Firidis 
Fluidum.,  1Tlij  to  TTlv  ;  veratrina,  gr.  -55  to  tV. 

Dental  Uses. — In  dental  practice,  the  tincture  of  veratrum 
viride  has  been  employed  internally  for  neuralgia  of  the  fifth 
nerve;  also  in  periodontitis,  as  a  sedative;  also  in  severe  hemor- 
rhage from  the  extraction  of  teeth,  to  depress  the  heart's  action. 


574  DENTAL  MEDICINE. 


DENTAL    FORMULA. 

For  Facial  Neuralgia. 

Da  Costa. 

R.         VeratricC gr.xv 

Aconitae gr.ij 

Glycerine f^ij 

Cerati  adipis .  f^vj.  M 

SiGNA. — To  be  rul)bed  over  painful  part,  care  being  taken  to  see  that 
there  is  no  abrasion  of  the  skin. 


XANTHOXYLUM— PRICKLY    ASH. 

Source. — Xanthoxylum  is  a  shrub  growing  in  the  northern  mid- 
dle and  western  States  of  North  America.  The  bark  is  the 
officinal  portion,  and  is  obtained  in  the  form  of  pieces,  more  or 
less  quilled,  of  one  or  two  lines  in  thickness  and  of  a  whitish 
color,  with  an  ash-colored  epidermis.  It  is  quite  inodorous  and 
has  a  taste  at  first  sweetish  and  slightly  aromatic  and  afterwards 
bitter  and  acrid. 

Medical  Properties  and  Action. — Xanthoxylum  is  aromatic, 
stimulant  and  sialogogue,  and  when  swallowed  occasions  a  sense 
of  heat  in  the  stomach,  more  or  less  general  arterial  excitement, 
and  a  tendency  to  diaphoresis. 

Therapeutic  Uses. — Xanthoxylum  has  been  administered  with 
considerable  benefit  in  the  chronic  form  of  rheumatism. 

Dose. — Of  powdered  xanthoxylum,  gr.  x  to  5ss,  three  or  four 
times  a  day. 

Dental  Uses. — Xanthoxylum,  in  the  form  of  the  powder,  has 
been  applied  with  success  to  an  aching  pulp  for  the  relief  of 
odontalgia,  and  a  decoction  of  the  bark  is  employed  as  a  wash 
for  foul  ulcers  ;  in  the  form  of  a  tincture  it  is  efficacious  in  re- 
lieving the  soreness  which  remains  after  the  extirpation  of  the 
dental  pulp ;  it  is  applied  on  floss  silk  or  cotton.  In  the  South- 
ern States  the  Angelica  Tree — Aralia  Spinosa.^  sometimes  called 
"Toothache  Tree,"  is  often  called  prickly-ash,  but  it  differs 
from  xanthoxylum,  although  its  tincture  answers  for  the  relief  of 
odontalgia. 


CHLORIDE  OF  ZINC.  575 


CHLORIDE  OF  ZINC— ZINCI  CHLORIDUM. 

Formula. — ZnClj. 

Derivation. — Chloride  of  Zinc  is  obtained  by  the  action  of 
hydrochloric  acid  on  granulated  zinc,  the  solution  thus  made 
being  purified  by  a  solution  of  chlorine  and  carbonate  of  zinc 
when  it  is  evaporated  till  it  assumes  a  solid  form.  It  is  in  the 
form  of  a  white  deliquescent  salt,  freely  soluble  in  water,  alcohol 
and  ether,  as  soft  as  wax  and  capable  of  being  melted  and 
sublimed  by  heat.  As  it  rapidly  deliquesces  when  exposed  to  the 
air,  it  should  be  kept  in  glass-stoppered  bottles.  It  has  a  styptic, 
metallic  taste,  which  is  very  disagreeable. 

Medical  Properties  and  Action. — Chloride  of  zinc  is  the  most 
active  of  the  zinc  preparations,  being  a  powerful  and  penetrating 
escharotic.  Its  local  action  as  a  caustic  depends  upon  its  affinity 
for  albumen  and  gelatin,  and  when  in  contact  with  living  parts  it 
destroys  their  vitality,  and  uniting  with  the  albuminous  and  gelat- 
inous matters  present,  forms  an  eschar.  It  is  also  a  useful  anti- 
septic, deodorizer  and  disinfectant,  and  largely  diluted  has  been 
.employed  as  a  nervine  tonic  ;  but  as  the  milder  preparations  of 
zinc  answer  the  same  purpose,  it  is  rarely  employed  internally. 
On  account  of  the  great  affinity  for  water  and  its  power  of  com- 
bination with  albumen,  chloride  of  zinc  penetrates  and  spreads 
deeply,  and  produces  an  eschar  which  is  white,  thick  and  hard. 
When  applied  to  malignant  and  indolent  ulcers,  it  promotes 
healthy  granulations,  and  also  when  topically  applied  it  not  only 
destroys  the  diseased  structure,  but  excites  a  new  and  healthy 
action  in  the  surrounding  parts.  When  employed  as  a  caustic,  it 
does  not  give  rise  to  constitutional  disorder  from  absorption,  an 
effect  which  is  sometimes  caused  by  arsenical  preparations.  In 
over-doses  it  causes  a  burning  pain  in  the  throat  and  stomach, 
nausea,  vomiting,  cold  sweats,  decrease  of  pulse,  cramps  of  the 
limbs,  etc.,  being  a  powerful  irritant  poison.  The  antidotes  in 
poisoning  by  zinc  salts  are  albumen,  carbonate  of  soda,  magnesia 
and  soap. 

Therapeutic  Uses. — Chloride  of  zinc  has  been  employed  inter- 
nally in  chorea,  epilepsy,  neuralgia,  scrofula,  and  combined  with 
hydrocyanic  acid,  in  facial  neuralgia.      Externally  it  is  applied  to 


576  DENTAL  MEDICINE. 


malignant  growths,  gonorrhoea,  indolent  ulcers,  etc.     A  solution 
of  the  chloride  of  zinc  is  used  as  an  antiseptic  and  disinfectant. 

Liquor  Zinci  Chloridi — Solution  of  Chloride  of  Zinc — known 
as  "  Burnett's  Disinfecting  Fluid,"  is  composed  of  chloride  of 
zinc,  gr.  cc,  water,  .5j. 

Dose. — Of  chloride  of  zinc,  gr.  ss  or  gr.  j,  or  gr.  ij,  largely 
diluted. 

Dental  Uses. — Chloride  of  zinc  is  a  valuable  agent  in  dental 
practice,  being  employed  as  an  external  application  to  sensitive 
dentine.  As  an  obtunding  agent,  a  drop  of  the  deliquescent 
chloride  is  placed  in  contact  with  the  sensitive  dentinal  surface 
(which  has  previously  been  dried  and  is  protected  from  all  mois- 
ture), and  allowed  to  remain  from  two  to  four  minutes.  Con- 
siderable pain  follows  the  application  of  the  chloride,  which  is  of 
a  steady  continuous  character,  without  the  throbbing  nature 
which  characterizes  the  pain  of  an  irritated  dental  pulp.  Its 
painful  action  may  be  modified  by  bathing  the  sensitive  surface, 
prior  to  the  application  of  the  chloride,  with  chloroform,  tincture 
of  aconite  or  atropine  solution,  or  a  combination  made.  When 
the  pain  has  subsided,  the  excavation  of  the  cavity  can  be  pro- 
ceded  with  until  the  layer  of  dentine  affected  by  the  chloride  has 
been  removed,  when  another  application  may  be  necessary.  As 
it  is  not  absorbed  by  the  dentine  to  any  great  degree,  its  action 
being  superficial,  it  is  not  so  dangerous  an  agent  as  is  arsenious 
acid  when  employed  for  the  same  purpose. 

In  no  case  should  the  chloride  of  zinc  be  used  as  an  obtunding 
agent,  when  there  is  danger  of  irritating  the  pulp  of  the  tooth. 

Chloride  of  zinc  is  also  employed  to  arrest  superficial  hemor- 
rhage from  a  wound  of  the  gum  during  the  filling  of  teeth ;  it 
will  also  temporarily  arrest  the  secretion  of  mucus  from  the  sur- 
face of  the  mucous  membrane  of  the  mouth.  When  applied  to 
a  cut  surface,  diluted,  it  induces  union  by  first  intention,  by  its 
effect  upon  the  glutinous  matter. 

It  has  also  been  successfully  employed  as  an  injection  for 
chronic  alveolar  abscesses,  and  in  the  treatment  of  ulceration  of 
the  gums  attended  with  recession  of  gum  and  absorption  of  proc- 
ess from  the  necks  of  teeth ;  also   as  an  injection  in  disease  of 


IODIDE  OF  ZINC.  577 

the  antrum.  It  has  been  claimed  that  its  application  in  a  diluted 
form  will  promote  the  formation  of  secondary  dentine  over  a 
nearly  exposed  pulp,  but  its  escharotic  action  must  be  considered 
in  using  the  agent  for  such  a  purpose.  When  applied  to  the 
sulcus  which  often  forms  during  ulceration  and  recession  of  the 
gum  from  the  neck  of  a  tooth,  the  application  can  be  safely  and 
conveniently  made  by  means  of  a  camel's-hair  brush,  or  by  a 
piece  of  orange  wood  so  shaped  as  to  permit  of  its  being  intro- 
duced to  the  bottom  of  such  a  sulcus. 

Chloride  of  zinc  is  also  employed  as  a  stimulating  astringent 
in  alveolar  pyorrhoea  in  the  form  of  a  solution  of  five  to  ten 
grains  to  the  ounce  of  water.  Chloride  of  zinc  in  a  properly 
diluted  form  is  an  efficient  disinfectant,  and'has  been  employed 
for  such  a  purpose  in  gangrenous  conditions  of  the  mouth. 

Chloride  of  zinc  is  one  of  the  ingredients  of  the  temporary 
filling  material  composed  of  the  chloride  of  zinc  in  solution  and 
the  oxide  of  zinc,  which  has  been  employed  to  cap  the  exposed 
pulps  of  teeth.  But  owing  to  the  escharotic  action  of  the  chloride 
this  method  has  not  been  uniformly  successful.  The  zinc 
preparations,  however,  answer  good  purposes  as  temporary  filling 
materials,  especially  in  sensitive  cavities  where  the  presence  of 
metallic  fillings  would  not  be  tolerated.     (See  Oxide  of  Zinc.) 

DENTAL    FORMULA. 

For  Inflamed  Gums  and  Mucous  Membrane. 

Dr.  W.  S.  Elliott. 

R.        Zinci  chloridum grs.  x 

Acidi  carbolici gtts.  xx 

Glycerini 

Aquae aa^ss.  M. 

Sulpho-carholate  of  zinc  has  to  a  great  extent  replaced  the 
chloride  of  zinc  as  an  antiseptic,  as  it  is  less  toxic  and  irritating 
and  much  more  potent. 

ZINCI  lODIDUM— IODIDE  OF  ZINC. 

Formula. — 7.1x1^. 

Derivation. — Iodide  of  zinc  is  obtained  by  digesting  an  excess 
37 


578  DENTAL  MEDICINE. 

of  zinc  with  iodine  diffused  in  water.  It  is  in  the  form  of  fine, 
white,  deliquescent  needles,  very  soluble  in  water,  and  of  a 
metallic,  styptic  taste,  resembling  that  of  sulphate  of  zinc,  and  is 
very  liable  to  spontaneous  combustion. 

Medical  Properties  and  Action. — Iodide  of  zinc  is  tonic, 
astringent  and  antispasmodic. 

Therapeutic  Uses. — Iodide  of  zinc  has  been  favorably  employed 
in  chorea,  cachexia,  scrofula  and  hysteria.  It  has  been  used  for 
strumous  inflammations  and  enlargements,  both  externally  and 
internally.  Externally  it  is  an  efficient  local  stimulant  and 
escharotic,  and  is  considered  to  be  equal,  if  not  superior  to 
chloride  of  zinc.  In  enlarged  tonsils  it  has  been  advantageously 
employed  in  a  solution  of  lO  to  30  grains  to  the  ounce  of  water. 
In  the  form  of  an  ointment  composed  of  a  drachm  of  the  iodide 
to  the  ounce  of  lard,  it  has  been  used  in  the  treatment  of  tumors. 

Dose. — Of  iodide  of  zinc,  gr.  j,  gradually  increased  to  gr.  vj, 
given  in  the  form  of  syrup. 

Dental  Uses. — Iodide  of  zinc  is  a  valuable  local  application  in 
alveolar  pyorrhoea,  tumors  of  the  mouth,  enlargement  of  the  ton- 
sils, etc.  In  alveolar  pyorrhoea  it  is  used  in  connection  with 
peroxide  of  hydrogen,  which  see. 

DENTAL    FORMUL-ffi. 

/^or  Alveolar  Pyorrhea.  For  Alveolar  Pyorrhxa. 

A.  W.  Harlan.  A.  W.  Hari.an. 

R .    Zinci  iodi  .    .    .  gr.  xij  to  xxiv  R .    Zinci  iodi gr.x 

Aquae  ....  f^j.  M.  Aquse TTL'^c.       M. 

SiGNA. — After  drying  the  gums,  inject  SiGNA. — Inject   with  a  syringe  if  the 

each    pus-pocket   with   one,   two  or  pockets  are   shallow   without  much 

three  drops  of  this  solution.  carious  process. 

ZIXCI  OXIDUM— OXIDE  OF  ZINC. 

Formula . — Z  n  O . 

Derivation. — Oxide  of  zinc  is  obtained  by  subjecting  precipi- 
tated carbonate  of  zinc  to  a  red  heat,  till  the  whole  of  the  car- 
bonic acid  and  water  are  expelled. 

It   is   in   the    form  of  a  yellowish-white  powder,  insoluble    in 


OXIDE  OF  ZINC.  579 


water,  but  soluble  in  dilute  sulphuric  and  hydrochloric  acids, 
without  effervescence.     It  is  inodorous  and  tasteless. 

Medical  Properties  and  Action. — Oxide  of  zinc  is  tonic  and 
antispasmodic,  but  in  large  doses  causes  vomiting  and  purging ; 
by  gradually  increasing  the  dose,  large  quantities  can  be  taken 
without  injurious  effects.  It  should  never  be  given  on  an  empty 
stomach,  as  it  may  cause  nausea. 

Therapeutic  Uses. — It  is  employed  in  spasmodic  asthma,  con- 
vulsions of  children,  epilepsy,  chorea,  whooping-cough,  hysteria, 
and  is  an  excellent  remedy  for  gistralgia ;  also  in  chronic  diar- 
rhoea and  chronic  dysentery. 

Dose. — Of  oxide  of  zinc,  gr.  ss  to  gr.  x. 

Denial  Uses. — Oxide  of  zinc  may  be  employed  in  the  treatment 
of  convulsions  of  children  during  dentition,  given  in  doses  of  gr. 
ss  to  gr.  V,  gradually  increased  to  gr.  viij,  in  powder,  with  a  little 
sugar.  It  is  also  combined  with  carbolic  acid,  in  a  fluid  form, 
for  capping  exposed  pulps,  being  applied  in  the  form  of  a  paste  to 
the  exposed  surface  of  the  dental  pulp.  It  also  forms  an  ingredi- 
ent of  the  zinc-filling  materials,  and  of  the  celluloid  base  for  arti- 
ficial teeth.  Dr.  Edw.  Eggleston  recommends  a  combination  of 
oxyphosphate  and  gutta  percha  as  a  filling  material  for  large 
cavities  in  proximal  surfaces  of  posterior  teeth,  extending  below 
gum  margin.  The  cavity  is  first  filled  one-third  full  of  gutta 
percha  and  completed  with  the  oxyphosphate.  It  is  generally 
supposed  that  alkalies,  especially  ammonia,  have  more  effect  in 
disintegrating  oxyphosphate  fillings  in  the  mouth  than  have  acids. 

DENTAL  FORMULA. 

Oxyphosphate  of  Zinc  Preparation  for  LIQUID, 

Filling  Teeth.  g .     Acidi  phosphorici, 

POWDER.  Aquje q.s.  to  dissolve 

5 .     Zinci  oxidi partes  200  and  evaporate  the  solution  by  aid  of 

Silicii  (fine  powd.)  .    .  partes  viij  heat,  until  it  is  of  the  consistence  of 

Sodii  boratis     ....  partes  iv  glycerine. 

Pulv.  glass partes  v  Another  Formula  for  the  Oxyphos- 

Levigate  under  water  to  ensure  com-  phate  Preparation  in  which  simply  the 

plete  admixture,  and  dry  by  evapora-  calcined    oxide    of    zinc    and   glacial 

tion ;  then  calcine  at  white  heat ;  then  phosphoric  acid  are  employed,  is  pre- 

reduce  to  powder.  pared  as  follows : — • 


580 


DENTAL  MEDICINE. 


Calcine  the  oxide  of  zinc  for  two 
hours  at  a  white  heat,  or  until  it  becomes 
a  hard,  yellowish  mass  ;  then  pulverize 
in  a  mortar,  and  sieve  through  fine 
bolting  cloth.  For  the  liquid  take  ^j 
of  glacial  phosphoric  acid  (German), 
in  crystals,  and  dissolve  in  f^  j  of  water, 
<and  then  evaporate  to  one-third,  on  a 
sand  bath. 


Oxy chloride  of  Zinc  Preparation  for 
Filling  Teeth. 


R .     Zinci  oxidi gr.xxx 

Sodii  boracis gr.ij 

Silicii  (fine  powd.)  .  .  gr.j. 
Mix  thoroughly  and  subject  to  a 
bright-red  heat  in  a  crucible.  Then 
grind  this  frit  to  a  powder,  and  mix  it 
with  three  times  its  weight  of  calcined 
oxide  of  zinc. 


LIQUID, 
K,     Zinci  chloridi  (deliq.)  .  f^j 

Aquae f  ^  v  to  vj. 

For  A^euralgia  of  the  Head. 
Von   NlEMEYER. 

R.     Ext.  hyoscyami, 

Zinci  oxidi  .    .    .    .  aa  ^ij.     M. 
SiGNA. — Fiat  pill,  xj. 

Begin  with  one  pill  morning  and 
evening,  and  increase  to  xx  or  xxx 
daily. 

For  Pulp  Devitalization. 
Dr.  Crissman. 
R .     White  oxide  of  zinc  .    .    .  y% 
Hydrochlorate  of  Cocaine, 

crystals  of y^ 

Creasote  q.  s.  to  make  a  paste. 
After  removal,  apply  tannin  dissolved 
in  glycerine  or  alcohol. 


ZINCI  SULPHAS— SULPHATE  OF  ZINC. 

/'orww/tf.— ZnS04+ 7H2O. 

Derivation. — Sulphate  of  zinc  is  obtained  by  the  action  of 
sulphuric  acid  on  granulated  zinc,  the  solution  being  purified  by 
means  of  chlorine  and  carbonate  of  zinc,  and  afterward  evapo- 
rated, the  product  being  crystals  of  sulphate  of  zinc.  It  is  in  the 
form  of  colorless  crystals,  which  effloresce  on  exposure  to  air^ 
and  are  soluble  in  water  and  insoluble  in  alcohol,  resembling  in 
appearance  Epsom  salts.  It  has  a  disagreeable,  metallic,  styptic 
taste. 

Medical  Properties  and  Action. — Sulphate  of  zinc  is  tonic, 
astringent,  antispasmodic,  and,  in  large  doses,  emetic.  Exter- 
nally, it  is  stimulant  and  astringent.  When  its  use  is  long  con- 
tinued, it  produces  symptoms  like  those  of  lead.  When  ad- 
ministered in  proper  doses,  it  exerts  an  antispasmodic  influence 
on  the  nervous  system,  and  where  there  is  spasm  and  convulsion^ 
it  is  very  serviceable. 

Therapeutic    Uses. — It  is   internally  administered   in   epilepsy^ 


ANTISEPTICS  IN  DENTAL  PRACTICE.  581 

chorea,  hysteria,  angina  pectoris,  chronic  dysentery,  flatulence, 
night  sweats  of  phthisis,  etc.,  and  is  a  prompt  emetic  in  cases  of 
narcotic  poisoning.  Internally,  it  is  employed  in  the  treatment 
of  gonorrhcea  of  the  eye,  chronic  skin  diseases,  epithelioma, 
ulcers,  gangrene,  etc. 

Dose. — Of  sulphate  of  zinc,  gr.  ^to  gr.  vi.  For  an  emetic 
in  cases  of  poisoning  six  grains  will  prove  sufficient,  well 
diluted  with  water,  and  repeated  every  fifteen  minutes  until 
emesis  occurs. 

Dental  Uses. — Sulphate  of  zinc  is  employed  internally  in  den- 
tal practice,  in  gangrene  of  the  mouth,  disease  of  the  antrum, 
ulcerations  of  mucous  membrane,  and  indolent  ulcers,  acting  as 
a  stimulant  and  astringent. 

Dr.  Northrop  recommends  for  alveolar  pyorrhoea  a  saturated 
solution  of  sulphate  of  zinc,  a  saturated  solution  of  iodide  of 
potassium,  equal  parts,  which  combination  in  turn  is  saturated 
with  the  crystals  of  iodine. 

DENTAL    FORMULA. 

/''or  Gangrene  of  the  Aloiith  (^Cancriun       For  Ulceration  of  Mucous  Membrane 
Oris).  of  the  Mouth. 

R.     Zinci  sulphas  ....  gr.xx  R  .     Zinci  sulphas  ....  gr.j  to  v 

Mellis ^].         M.  Aquae  destillatse     .    .  ^j.         M. 

SiGNA. — To  be  applied  with  a  camel's-  SiGNA. — To   be   used  as  a  gargle  or 
hair  brush.  lotion. 

For  Chronic  Alveolar  Abscesses,  Abscess  of  Antrum,  etc. 
Dr.  G.  L.  Parmele. 

R.         Zinci  sulphas gr-i'j 

Plumbi  acetas gr.v 

Tine,  catechu ,    ...  gtt.x 

AquK f^j.  M. 

Signa. — Use  as  a  stimulating  injection. 

ANTISEPTICS  IN  DENTAL  PRACTICE. 

The  term  antiseptis  implies  the  prevention  of  septic  influence 
or  putrefaction  in  wounds,  and  the  healing  of  wounds  by  first 
intention  or  without  suppuration. 

Jntiseptics  are   medicinal   substances  which   possess  the  power 


582  DENTAL  MEDICINE. 


of  arresting  the  process  of  putrefaction,  and  they  embrace  such 
drugs  as  organic  (vegetable)  acids,  inorganic  (mineral)  acids,  the 
former,  such  as  carbolic,  salicylic  and  benzoic  acids  being  ap- 
plicable to  tooth  structures,  and  tooth  tissues ;  while  the  latter, 
such  as  nitric,  sulphuric,  hydrochloric,  boracic  and  chromic 
acids,  are  restricted  to  the  treatment  of  tooth-tissues ;  also,  the 
iodides,  which  include  the  tincture  of  iodine,  iodoform,  iodol, 
potassium  iodide,  aseptol,  aristol ;  also  the  mercurials,  such  as  the 
bichloride  and  biniodide  of  mercury  ;  also  such  oxidizing  agents 
as  peroxide  of  hydrogen  and  permanganate  of  potash ;  also  the 
essential  oils,  such  as  cajuput,  cassia,  peppermint,  cloves,  thyme, 
turpentine,  caraway,  mustard,  eucalyptus,  juniper,  gaultheria,  cin- 
namon, eugenol,  sassafras,  pennyroyal,  valerian,  etc. ;  also  the 
wood  and  coal-tar  derivatives,  such  as  creasote,  hydronaphthol, 
resorcin,  lysol,  etc. ;  also  heat.  The  methods  of  using  antiseptics 
in  dental  practice  are  by  irrigation,  disinfection,  and  as  antiseptic 
dressings.  Irrigation  consists  in  washing  out  cavities  in  teeth, 
applications  to  inflamed  and  infected  surfaces,  syringing  abscesses, 
and  the  use  of  mouth  washes  or  lotions,  diluted  aqueous  solu- 
tions or  antiseptic  agents  being  considered  preferable  to  concen- 
trated solutions  for  such  purposes. 

Disinfection  consists  in  the  destruction  of  micro-organisms 
and  the  products  of  fermentation  and  putrefaction  in  carious 
cavities,  pulp-canals,  gangrenous  pulps,  etc. 

Antiseptic  dressings  or  applications  are  in  the  form  of  pow- 
ders, solutions  and  pastes,  or  mixed  with  filling  materials,  such 
as  the  preparations  of  zinc.  When  acids  are  used  as  antiseptics, 
they  must  be  so  diluted  as  to  deprive  them  of  their  caustic  prop- 
erties or  action,  and  the  mercurials,  such  as  the  bichloride, 
must  be  in  such  weak  solutions  as  will  prevent  toxic  effects  on 
the  system.  Different  antiseptics  are  required  according  to  the 
anatomical  structure  of  the  part  on  which  they  are  to  act,  and 
also  its  physical  condition,  as  the  inflammation  present  may  be 
either  acute,  or  chronic,  or  the  tissue  be  in  a  septic  or  putrescent 
state  ;  hence,  each  condition  demands  a  particular  class  of  anti- 
septics. The  strength  of  the  antiseptic  employed  will  also 
depend  upon  the  condition  of  the  tissue  or  structure  at  the  time 


ANTISEPTICS  IN  DENTAL  PRACTICE.  533 


of  application.  Dr.  W.  D.  Miller  has  established  the  re- 
lationship of  micro-organisms  to  the  etiology  of  dental  caries, 
and  also  shown  that  all  fermentative  and  putrefactive  processes 
of  the  dental  pulp  and  oral  mucous  membrane  are  conditioned  by 
the  presence  of  living  bacteria.  From  recent  experiments  made 
by  Dr.  Miller  on  the  comparative  value  of  antiseptics  for  steril- 
izing cavities,  etc.,  he  concludes  that  bichloride  of  mercury, 
"  which  usually  ranks  as  the  king  among  antiseptics,"  and  gave 
uniformly  good  results  in  one  method  he  employed,  fell  consider- 
ably short  of  the  striking  action  shown  by  the  trichloride  of 
iodine,  and  he  further  remarks  that  "  we  have  consequently 
reasons  to  hope  that  the  trichloride  of  iodine  may  prove  a  valu- 
able remedy  in  the  treatment  of  diseased  conditions  of  the  teeth 
and  mouth,  and  that  the  five  per  cent,  solution  is  one  of  the  most 
active  agents  at  our  demand  for  disinfecting  carious  dentine.  Of 
carbolic  acid,  he  says,  while  it  is  a  very  active  antiseptic  agent, 
it  falls  considerably  behind  the  bichloride  of  mercury  and  tri- 
chloride of  iodine  in  its  penetrating  power.  Of  lysol  and  tri- 
chlorphenol,  he  says  that  the  results  were  very  similar  to  those 
obtained  by  carbolic  acid.  Of  peroxide  of  hydrogen,  he  says, 
that  although  it  is  an  excellent  sterilizer  for  thin  layers  of  carious 
dentine,  it  fails  when  applied  to  thicker  ones,  as  antiseptics  ap- 
plied to  cavities  of  decay  on  cotton  naturally  retain  their  power 
but  a  few  hours  ;  pledgets  of  cotton  saturated  with  carbolic  acid 
and  placed  in  large  cavities  near  the  gums,  lose  their  antiseptic 
action  in  twenty-four  hours.  Of  chloride  of  zinc,  he  thinks 
that  although  it  penetrates  the  tissue  quite  rapidly,  yet  its  anti- 
septic power  is  inferior  to  that  of  many  other  available  antisep- 
tics, and  that  the  pain  attending  its  application  to  the  nearly  ex- 
posed pulp,  more  than  counterbalances  any  slight  advantage  it 
might  otherwise  have  over  carbolic  acid. 

Hydronaphthol  showed  considerable  penetrating,  antiseptic 
and  consequently  preservative  action.  Iodoform  he  considers 
to  be  one  of  the  most  worthless  antiseptics,  and  that  this  fact 
has  not  been  revealed  long  ago  is  in  part  due  to  the  circumstance 
that  it  is  nearly  always  employed  in  conjunction  with  some 
other  material,  such  as  carbolic  acid,  oil  of  cloves,  etc. 


584  DENTAL  MEDICINE. 


The  essential  oils,  pyoktanin,  benzoic  acid,  alcohol,  thymol 
and  resorcin,  all  fell  far  short  of  the  standard  of  efficiency  main- 
tained by  other  antiseptics  for  sterilizing  carious  cavities.  He 
found  that  thymol  and  salicylic  acid  manifested  an  evident  pre- 
servative action  upon  the  dental  pulp,  but  the  effects  were  con- 
fined to  a  small  portion  of  the  pulp.  Of  the  two,  thymol  gave 
the  better  results.  Of  the  aniline  colors,  methyj  violet  and 
methylene  blue,  neither,  he  says,  has  the  slightest  preservative 
action,  nor  did  they  penetrate  the  pulps  to  a  depth  of  more  than 
a  quarter  of  an  inch.  Campho-phenique,  he  says,  appeared  to 
penetrate  the  pulp-tissue  about  as  rapidly  as  carbolic  acid,  and 
moderately  hardened  the  tissue,  giving  to  it  antiseptic  properties 
by  the  absorption  of  the  solution,  but  not  equal  to  that  imparted 
by  carbolic  acid  alone. 

The  antiseptics  Dr.  Miller  found  to  be  preeminently  active 
in  preventing  decomposition  of  pulp-tissue,  were  :  bichloride  of 
mercury,  cyanide  of  mercury  (?),  trichlorphenol,  sulphate  of 
copper,  carbolic  acid,  oil  of  cloves,  chloride  of  zinc,  campho- 
phenique  (?),  hydronaphthol  (?). 

Those  of  doubtful  value  :  thymol,  salicylic  acid,  eugenol,  a 
and  b  naphthol,  acetico-tartrate  of  aluminum,  five  per  cent,  solu- 
tion of  bichloride  of  mercury,  and  possibly  some  essential  oils. 

According  to  Dr.  Black,  "  infectious  matter  contains  living 
particles  that  will  grow  and  reproduce  themselves.  Septic 
matter  may  be  in  solution ;  it  is  poisonous.  It  is  the  product  of 
the  growth  of  micro-organisms,  and  it  is  this  product  of  the 
dentine  that  is  dangerous  in  many  cases,  to  the  exclusion  of 
infectious  matter;  for  while  infectious  matter  may  be  in  the 
dentine,  may  live  there  for  a  time,  it  certainly  will  not  live  there 
very  long  if  communication  by  which  it  receives  food  is  cut  off. 
It  must  receive  food  in  any  case,  and  must  get  clear  of  its  waste 
products  or  it  will  soon  be  choked.  Though  microbes  may  not 
be  present  in  the  dentine,  there  is  danger  of  poisoning  from  the 
septic  matter  that  is  absorbed,  filling  the  dentinal  tubules.  We 
have  a  different  set  of  conditions  when  we  leave  a  little  bit  of 
softened  dentine  over  a  pulp  nearly  exposed.  We  may  cover  in 
the  anaerobic  microbes.      In  a  short  time  they  produce  products 


ANTISEPTICS  IN  DENTAL  PRACTICE.  555 

that  will  destroy  the  pulp,  or  they  may  pass  through  and  pene- 
trate into  the  pulp,  and  we  may  have  an  infected  pulp  presently 
from  the  microbes  we  have  covered  in.  This  action  is  brought 
about  rapidly,  and  the  poisonous  matter  escapes  toward  the  pulp. 
If  we  have  covered  them  in  with  the  filling  we  have  sealed  up 
the  elements  for  destroying  that  pulp.  It  is  not  necessary  that 
the  dentine  be  softened  more  ;  it  may  not  be  a  class  of  microbes 
that  soften  dentine.  It  is  a  microbe  that  attacks  the  sarcous 
elements  of  the  body  ;  the  contents  of  the  dentinal  tubes  are 
attacked  just  as  well.  So  here  we  need  a  disinfectant.  What 
shall  we  use  ?  Certainly  not  one  of  the  coagulants  (such  as 
carbolic  acid,  creasote  and  chloride  of  zinc — agents  which  seal 
the  septic  matters  within  the  teeth);  certainly  not  one  that  places 
a  barrier  to  its  own  penetration  by  coagulating  the  albumen. 
These  are  not  the  antiseptics  you  should  use  in  this  place,  but 
something  we  can  depend  upon  to  penetrate  in  the  presence  of 
albumen,  and  we  find  that  to-day  in  the  use  of  the  essential  oils, 
and  among  them  the  oil  of  cassia  is  the  most  potent.  There  are 
many  of  the  essential  oils  that  when  used  in  substance  will 
destroy  microbes  just  as  quickly  as  the  oil  of  cassia,  and  among 
them  may  be  mentioned  the  oil  of  turpentine,  but  there  is  none 
of  them  that  will  destroy  microbes  so  rapidly  and  so  certainly 
with  that  proportion  of  the  oil  that  will  dissolve  in  water,  or  the 
fluid  with  which  they  come  in  contact  in  their  application  in 
practice  as  the  oil  of  cassia.  In  bacteriology,  the  terms  germ^ 
bacteria^  microbe^  schizomycetes^  are  used  almost  as  synonymous 
names,  but  microbe  seems  preferable  to  germ  or  bacteria,  and 
schizomycetes  is  considered  to  be  a  better  scientific  term  than 
either.  It  is  also  conceded  that  these  are  unicellular  and 
assimilate  nourishment  apparently  by  absorption  in  the  media  in 
which  they  live,  but  they  must  alter  their  foods  found  proper, 
and  yet  unfit  in  nature  for  their  use  and  appropriation.  Bacteria, 
living  or  dead  matter  encounter  no  living  resistance,  while  those 
feeding  on  living  tissues,  or  fluids  in  living  tissues,  meet  the 
living  cells  of  the  body  and  have  to  combat  them.  The  dias- 
tases secreted  by  the  various  beings,  whether  highly  organized, 
or   unicellular  and   microscopic,  have   something    in   common  as 


586  DENTAL  MEDICINE. 


to  their  respective  objects  and  their  properties  of  transforming 
matter.  The  roll  of  microbes  in  existence  is  complex  and 
necessary,  though  some  are  injurious.  They  act  as  scavengers, 
return  to  the  air  and  water  the  organizable  elements  abstracted 
daily  by  the  vegetables  and  indirectly  by  animals,  and  are  indis- 
pensable to  life.  The  bacteria  that  invade  living  organisms 
vi'hich  happen  to  be  fit  for  their  nourishment  and  growth  are 
considered  to  be  parasites.  The  spontaneous  generation  of  living 
organisms,  no  matter  how  little,  is  now  regarded  as  a  fallacy. 

Formerly,  when  the  root-canal  of  a  tooth  was  opened  and 
found  to  be  empty  and  dry,  peridental  trouble  resulted.  But  the 
treatment  of  such  cases,  as  now  pursued,  consists  in  excluding 
the  saliva  and  atmospheric  microbes,  the  removal  of  every  particle 
of  debris,  and  the  application  of  antiseptics  and  disinfectants. 
To  render  a  pulp-canal  permanently  aseptic,  it  should  be  thor- 
oughly cleansed  with  either  alcohol,  peroxide  of  hydrogen  or 
ammonia,  using  a  syringe  to  prevent  septic  matter  being  forced 
through  the  foramen.  After  the  alcohol  has  evaporated,  or  the 
canal  thoroughly  dried  of  the  peroxide  of  hydrogen  or  ammonia, 
by  means  of  a  hot-air  syringe,  an  application  of  the  bichloride 
of  mercury  or  other  antiseptic  is  then  made,  and  the  canal  ren- 
dered permanently  aseptic.  In  an  open  pulp-canal  containing 
partly  devitalized  pulp  tissue,  the  same  care  must  be  exercised  to 
cleanse,  disinfect  and  render  aseptic.  When  alveolar  abscess 
exists  as  the  result  of  a  devitalized  pulp,  similar  treatment  is  in- 
dicated ;  and  in  all  cases  where  a  pulp  has  been  destroyed  by 
therapeutic  remedies  or  agents,  the  treatment  consists  in  cleans- 
ing, disinfecting  and  filling  the  pulp-canals. 

Dr.  A.  W.  Harlan  remarks:  "All  cavities  in  living  and  pulp- 
less  teeth  are  infected  through  the  agency  of  pathogenic  bacteria 
or  micrococci.  (Black,  Miles,  Underwood  and  Miller.)  These 
micro-organisms  and  other  septic  matters  cannot  be  destroyed  in 
excavating  a  cavity  in  a  living  tooth  short  of  destruction  of  the 
pulp  by  coagulating  drugs  save  in  rare  instances.  Dilute  solu- 
tions of  bichloride  of  mercury,  peroxide  of  hydrogen  and  some 
of  the  naphthol  compounds,  belong  to  this  class ;  coagulators 
cannot  be  used  in  a  sufficiently  diluted  state  to  accomplish  disin- 


ANTISEPTICS  IN  DENTAL  PRACTICE.  537 

fection  without  injury  to  the  parts  to  which  they  are  applied. 
Diffusible  drugs  will  destroy  septic  materials,  including  cause  of 
infection,  without  injury  to  the  living  hard  or  soft  tissues.  The 
above  will  apply  as  well  to  infected  pulpless  teeth,  and  this  is 
even  true  with  reference  to  the  coagulation  of  the  exposed  organic 
matrix  in  the  interior  of  a  tooth  partly  softened  by  caries.  Coag- 
ulating agents  simply  coagulate  and  leave  the  coagulum  to  be- 
come a  source  of  food  supply  to  the  aerobic  and  anaerobic 
microbes." 

Dr.  Harlan  recommends  the  following  for  softened  dentine : 
Corrosive  sublimate,  peroxide  of  hydrogen  and  tartaric  acid  com- 
bined, applied  with  wood  or  platinum  points ;  then  dry  the  cavity 
and  apply  myrtol  in  full  strength  and  dry  it  again.  He  also  says  : 
If  it  is  deemed  a  necessity  to  apply  an  antiseptic  agent  to  a  cavity 
in  a  tooth  having  a  living  pulp,  an  oil  (one  of  the  essential  oils, 
such  as  peppermint,  camphor,  turpentine,  thyme,  cassia,  cinna- 
mon, caraway,  eugenol,  cajuput,  eucalyptol,  terpinol,  mvrtol, 
sassafras),  may  be  left  in  contact  with  the  cavity,  sealed  with 
gutta  percha,  or  the  cavity  may  be  stopped  with  oxysulphate  of 
zinc  for  any  number  of  days.  The  cavity  should  be  well  dried 
before  introducing  the  oil.  He  also  remarks  that  there  is  no 
theoretical  objection  to  the  use  of  carbolic  acid  in  a  living  tooth, 
if  it  is  reapplied  from  time  to  time  perfectly  warmed.  It  should 
not  be  used  to  protect  the  pulp  from  the  invasion  of  micro- 
organisms or  deep-seated  cavities,  as  it  will  prove  inadequate  by 
lack  of  diffusibility. 

"  It  is  a  mistaken  idea  to  suppose  that  an  agent  like  carbolic 
acid,  liquefied  or  diluted  with  water,  will  prove  a  permanent 
antiseptic  in  the  presence  of  moisture,  such  as  is  nearly  always 
present  in  a  tooth.  It  does  not  possess  embalming  properties 
because  it  is  easily  absorbed  and  disappears.  It  should  form  no 
part  of  root-filling,  nor  should  it  be  introduced  into  roots  per- 
manently. Copal,  Canada  balsam,  or  other  agents  of  this  class, 
may  be  used  on  an  exposed  pulp  in  its  stead,  and  for  injection 
into  abscesses,  using  the  root  of  the  tooth  as  a  channel,  potass- 
permanganate,  silico-fluoride  of  sodium,  boro-glycerine,  the  oil 
of  cloves,  cassia,  cinnamon,  myrtol,  and  agents  of  this  class,  are 


588  DENTAL  MEDICINE. 


far  more  powerful,  with  better  stimulating,  antiseptic  and  disin- 
fectant properties,  and  they  do  not  possess  the  coagulating  prop- 
erties of  carbolic  acid,  or  its  disagreeable  odor,  and  under  no 
circumstances  will  they  clog  a  delicate  canal  or  destroy  the  soft 
tissue  to  which  they  are  applied.  Carbolic  acid  should  take  its 
legitimate  place  as  a  spray,  a  local  anaesthetic  and  component  of 
mouth  washes  in  dental  practice,  and  as  an  adjuvant  to  the  oils 
where  local  medication  around  the  roots  of  teeth  may  be  indi- 
cated, or  for  injection  into  the  antrum  of  Highmore,  combined 
with  tannin,  glycerine,  camphor  or  potash,  or  be  relegated  to  the 
laboratory  as  a  component  of  sodium  phenate,  or  in  other  chem- 
ical uses." 

Incompatible  Jntisept'ics. — Corrosive  sublimate  and  iodine  ;  cor- 
rosive sublimate  and  soap ;  iodine  and  soap ;  carbolic  acid  and 
iodine ;  carbolic  acid  and  permanganate  of  potassium ;  salicylic 
acid  and  soap ;  salicylic  acid  and  permanganate  of  potassium  ; 
permanganate  of  potassium  and  oils,  soap,  or  glycerine;  aristol  and 
caustic  alkalies,  ammonia,  mercuric  chloride,  metallic  oxides,  starch, 
or  any  substance  which  possesses  a  powerful  affinity  for  iodine. 

Disinfecting  or  Sterilizing  Instruments^  Etc. — Dr.  W.  D.  Miller, 
in  an  article  on  the  disinfection  of  dental  and  surgical  instru- 
ments, says :  "  There  is  no  department  of  surgery  in  which  the 
demand  for  antiseptic  procedure  is  more  urgent  than  in  dentistry, 
for  the  reason  that  all  of  our  operations  are  performed  upon  septic 
or  infected  tissues,  and  we  have  no  means  of  rendering  the  terri- 
tory to  be  operated  upon  aseptic  except  by  the  use  of  antiseptics 
of  the  highest  character.  We  cannot  extract  a  tooth,  cleanse 
the  canal  of  a  pulpless  tooth,  excavate  a  cavity  of  decay  or  lance 
the  gums ;  we  cannot  even  touch  any  point  in  the  oral  cavity 
without  our  instruments  becoming  coated  with  a  layer  of  infec- 
tious material.  We  are  therefore  bound  to  use  antiseptics,  not 
only  for  the  purpose  of  disinfecting  the  already  infected  tissues, 
but  for  sterilizing  our  instruments  to  avoid  the  transmission  of 
infectious  matter  from  one  patient  to  another."  "  The  neces- 
sity for  absolute  cleanliness  on  the  part  of  the  dentist,  of  his 
hands  as  well  as  of  his  instruments,  napkins,  drinking-glasses,  rub- 
ber-dam, in  short  of  everything  with  which  he  comes  in  contact 


ANTISEPTICS  IN  DENTAL  PRACTICE.  539 

with  the  patient's  mouth,  is  universally  recognized ;  at  least  there 
can  be  no  one  who  has  the  courage  to  express  a  contrary  opinion." 
"  We  can  never  know  what  virus  may  be  clinging  to  our  instru- 
ments, nor  can  we  with  certainty  predict  the  result  of  a  wound 
upon  the  gums,  cheeks  or  lips  with  an  unclean  instrument." 

From  Dr.  Miller's  experiments  we  deduct  the  following : 
Boiling  napkins  for  10  or  15  minutes  in  soap-water  completely 
sterilizes  them.  Small  pieces  of  rubber-dam  can  be  sterilized  as 
a  rule  by  exposing  them  for  30  minutes  to  a  five  per  cent,  solu- 
tion of  carbolic  acid ;  small  and  large  pieces  of  the  dam  are 
completely  sterilized  by  subjecting  them  to  boiling  water  for 
from  six  to  fifteen  minutes,  according  to  size. 

Drinking  or  rinsing  glasses  can  be  sterilized  by  boiling  in  pure 
water.  Concerning  instruments,  he  says  :  The  ideal  antiseptic 
is  a  liquid  which  acts  immediately  upon  bacteria  without  in  anv 
way  injuring  the  instrument.  His  results  were  as  follows  :  A 
five  per  cent,  solution  of  carbolic  acid  required  one  hour  to 
sterilize  instruments,  and  even  after  such  a  time  the  result  was 
not  certain ;  and  of  twenty-one  pieces  placed  in  concentrated 
carbolic  acid  for  varying  periods  of  time  ranging  from  one  to 
twelve  minutes,  only  two  were  sterilized. 

A  five  per  cent,  solution  of  trichlorphenol  required  an  hour's 
time  to  sterilize.  Lysol  gave  results  nearly  identical  with  those 
of  trichlorphenol.  An  action  of  from  fifteen  to  twenty  minutes 
in  a  five  per  cent,  aqueous  solution  of  the  bichloride  of  mercury 
gave  the  most  promising  result  and  can  be  relied  upon  to  produce 
thorough  sterilization  ;  but  he  considers  the  time  required  to  be 
so  long  as  to  render  a  five  per  cent,  solution  of  the  bichloride  of 
mercury  unsuitable  for  the  purpose ;  besides  the  powerful  action 
of  this  agent  upon  steel  or  iron  is  a  serious  objection  to  its  use  as 
a  sterilizer.  A  ten  per  cent,  solution  of  the  peroxide  of  hydrogen 
came  next  to  carbolic  acid,  but  is  considerably  inferior  to  it. 
The  essential  oils  in  emulsion,  as  well  as  in  pure  form  utterly 
failed  to  sterilize. 

He  finally  concluded  that  boiling  water  is  far  superior  to 
chemical  antiseptics,  and  all  other  means,  for  sterilizing  dental 
instruments,  and  that  its  easy  application  and  rapid  action  should 


590  DENTAL  MEDICINE. 

recommend  it  tb  every  practicing  dentist  and  physician.  He  re- 
gards an  exposure  of  three  minutes  to  boiling  water  sufficient  for 
sterilizing  the  smaller  dental  instruments,  and  five  minutes  for 
any  other.  The  addition  of  soda  will  prevent  the  rusting  which 
is  liable  to  occur  when  the  instruments  are  boiled  in  water  alone  ; 
hence  a  boiling  solution  of  carbonate  of  sodium  appears  to  be  the 
most  promising.  Dr.  Miller  recommending  an  exposure  of  three 
'to  five  minutes  to  a  boiling  one  or  two  per  cent,  solution  of  soda 
for  sterilizing  dental  and  surgical  instruments.  The  solution 
must  not  be  simply  hot,  but  boiling,  since  the  motion  of  the  boil- 
ing water  materially  assists  in  rapidly  raising  the  temperature  of 
the  instruments  to  ioo°  C,  and  at  the  same  time  loosens  up  any 
matter  that  may  be  clinging  to  them.  Solutions  of  such  agents 
as  bichloride  of  mercury,  campho-phenique  eugenol,  oil  of  cassia, 
oil  of  turpentine,  terpinol,  formaldehyde  gas  obtained  from  para- 
form,  lysol,  carbolic  acid,  aseptol,  trichlorphenol,  a  boiling  solu- 
tion of  carbonate  of  sodium,  steam,  are  employed  for  disinfecting 
dental  instruments  and  appliances.  Bichloride  of  mercury 
although  an  effective  sterilizer,  will  injure  instruments.  Steam 
is  an  efficient  sterilizer,  and  a  simple  method  for  its  use  is  recom- 
mended by  Dr.  K.  C.  Gibson ;  it  consists  in  placing  the  instru- 
ments in  a  cotton  or  linen  bag  tied  closely  at  the  top,  which  is 
put  into  the  ordinary  dental  vulcanizer,  and  subjected  to  steam 
pressure,  as  shown  by  the  thermometer,  of  230°  F.  for  ten  min- 
utes. A  small  quantity  of  bicarbonate  of  soda  placed  in  the 
water  will  prevent  the  instruments  from  rusting.  (See  Formaline 
for  disinfecting  instruments,  etc.,  with  formaldehyde  gas.) 

To  Render  the  Hands  Aseptic. — Dr.  Noble  says :  Trim  the 
nails  reasonably  short,  and  clear  the  subungual  spaces  with  the 
knife  blade.  Then  thoroughly  wash  the  hands  and  forearms  in 
warm  water,  a  good  lather  being  made  with  soap,  and  a  stiff  brush 
vigorously  applied.  Renew  the  water  three  times.  Next  soak 
the  hands  in  a  saturated  solution  of  oxalic  acid.  According  to 
circumstances  the  finger  tips  are  then  soaked  in  peroxide  of 
hydrogen.  For  the  final  bath,  corrosive  sublimate  solution,  i  to 
1000,  is  employed  ;  allow  the  hands  to  remain  in  this  solution 
three  minutes. 


CATAPHORESIS,  59I 


TEST-PAPERS  FOR  DENTISTS. 

Very  frequently  it  is  important  to  the  dentist  to  know  whether 
his  peroxide  of  hydrogen,  which  is  so  liable  to  change,  is  still 
good  or  has  become  decomposed  ;  or  whether  his  solution  of 
bichloride  of  mercury  has  become  inert  by  the  reducing  action  of 
organic  matter  in  the  water  under  the  influence  of  sunlight.  And 
so  of  many  other  chemicals  used  in  the  dental  office  which  are 
apt  to  change  in  strength. 

Prof.  Chas.  Mayr,  of  Springfield,  Mass.,  has  prepared  a  series 
of  test-papers,  which  will  enable  the  dentist  to  learn  quickly  and 
accurately  whether  his  preparations  are  good  or  worthless,  and 
without  the  use  of  cumbersome  methods.  They  are  put  up  in 
neat  little  books,  each  containing  eight  different  papers  (of  some, 
like  litmus,  several  papers  are  provided),  affording  sixty-four 
different  reactions.     The  papers  are  as  follows  : 

Phenyl-Carbinol^  for  strong  acids  and  alkalies. 

Turmeric^  for  alkalies. 

Sulphide^  for  solution  of  metals. 

Potassium  Iodide^  for  HgOg,  bichloride  557. 

Iodide  Starchy  for  hydrogen  peroxide. 

Litmus^  for  weak  acids  and  alkalies. 

Erythorine^  for  salts  and  alkalies. 

Lacmoid^  substitute  for  litmus,  not  affected  by  carbonic  acid. 

Each  paper  has  printed  upon  it  the  reactions  it  gives,  so  that 
even  the  inexperienced  have  a  safe  guide  as  to  its  uses. 

CATAPHORESIS. 

Cataphoresis,  Electrical  Diffusion,  and  Electrical  Osmosis  are 
terms  which  designate  a  method  of  treatment  for  hypersensitive 
dentine,  for  the  devitalization  of  pulps  of  teeth,  for  opening 
abscesses,  for  aborting  abscesses,  for  sterilizing  medications  in 
roots  of  teeth,  for  acute  periodontitis,  for  bleaching  discolored 
teeth,  for  sensitiveness  in  the  preparation  of  teeth  and  roots,  for 
crown   and  band   adjustment,  etc.,  etc.     The  definition  of  the 


592  DENTAL  MEDICINE. 

term  cataphoresis  as  given  by  Prof.  William  J.  Morton,  M.D., 
is,  "  The  movements  of  fluids,  together  with  the  substances  they 
hold  in  solution,  from  the  positive  pole  of  electrodes  conveying  a 
continuous  current  in  tissue  toward  the  negative  pole."  These 
fluids  contain  elements  in  solution  which  make  them  medicines, 
and  these  medicines  must  flow  from  the  positive  to  the  negative 
pole  conveyed  by  the  current ;  hence  if  application  is  made  to 
one  tissue  by  the  positive  pole,  and  to  any  remote  part  by  the 
negative  pole,  the  solution  has  a  tendency  to  flow  with  the  cur- 
rent, and  these  medicines  will  travel  in  that  direction. 

Although  any  form  of  battery  which  is  constant  when  the  am- 
perage of  the  individual  cell  is  from  one-fourth  to  five-eighths  of 
an  ampere,  will  answer,  yet  the  dry  chloride  of  silver  cell  is  prob- 
ably the  best  for  treatment  by  this  method,  on  account  of  its  con- 
stancy and  durability. 

The  voltage  which  concisely  represents  the  pressure  of  the 
current,  is  indicated  by  the  numbered  attachments,  and  the  pres- 
sure may  be  increased  at  pleasure.  The  milliampere  dial  records 
the  flow  of  the  current  through  the  tissues,  and  a  current  con- 
troller furnishes  in  the  smallest  quantities  further  pressure  upon 
the  tissue,  as  may  be  suggested  by  the  case  in  hand.  Clinical 
experience  suggests  that  as  regards  the  current  strength,  a  large 
voltage  is  not  necessary  in  securing  the  desired  results.  Gener- 
ally from  one-half  to  one  and  a  half  milliampere  registrations  will 
be  sufficient  to  anaesthetize  perfectly.  A  low  voltage  also  insures 
comfort  to  the  patient.  Another  important  element  is  uniform 
and  continuous  constancy  of  current  application.  If  the  current 
is  spasmodic  or  unreliable  in  any  degree,  the  result  sought  for  will 
be  impaired  and  the  comfort  of  the  patient  be  seriously  disturbed. 
The  continuous  application  of  the  current  should  be  maintained 
to  the  end  of  the  operation,  and  when  a  renewed  application  of 
the  anaesthetic  solution  is  desired,  no  disconnection  should  take 
place,  but  the  solution  should  be  added  with  the  appliance  in 
place. 

The  electrode  should  not  be  removed  from  the  point  where  it 
is  first  applied  until  after  the  current  is  shut  ofi^.  The  voltage 
required  to  produce  the  necessary  electro-motor  force  to  produce 


CATAPHORESIS.  593 


anaesthesia  of  the  dentine  of  a  tooth  varies  from  five  to  thirty 
cells.  For  children's  teeth  ten  cells  may  answer,  although  from 
fifteen  to  twenty  are  generally  required.  The  dry  Seclauche  bat- 
tery is  also  a  good  form  of  an  open  cell  appliance,  for  as  long  as 
the  circuit  is  open  there  is  no  loss.  The  dry  chloride  of  silver 
battery  will  usually  give  seven  hundred  hours  of  work  under  a 
high  resistance  of  tissue. 

Cocaine,  in  from  twelve  to  twenty-four  per  cent,  solutions  of 
the  hydrochlorate,  is  generally  employed  in  the  cataphoric  method, 
although  as  high  as  a  forty  per  cent,  solution  has  been  used.  One 
and  one-fifth  grains  of  hydrochlorate  of  cocaine  to  ten  minims  of 
distilled  water,  will  give  a  twelve  per  cent,  solution ;  the  same 
quantity  of  the  cocaine  to  seven  and  a  half  minims  of  water  will 
give  an  eighteen  per  cent,  solution,  and  a  similar  quantity  of  the 
salt  to  five  minims  of  the  water  will  give  a  twenty-four  per  cent. 
solution. 

The  citrate  of  cocaine,  eucaine,  tropacocaine,  quiacolcocaine 
oil  of  cassia  incorporated  with  a  trace  of  pulverized  soda  sul- 
phate, chloride  of  sodium,  and  cocaine  and  boric  acid  have  also 
been  used  with  good  results  in  the  cataphoric  treatment ;  and  in 
fact  any  local  anaesthetic  mixture  which  is  a  conductor  of  elec- 
tricity can  be  so  employed.  The  instrument  or  rheostat,  how- 
ever, should  be  so  constructed  as  to  give  the  operator  at  all  times 
perfect  control  of  the  current,  and  he  must  be  able  to  raise  this 
element  from  a  weak  to  a  strong  current,  by  such  minute  grada- 
tions that  it  will  be  almost  imperceptible  to  the  patient. 

The  application  of  the  rubber  dam  is  necessary,  so  adjusted 
that  no  leakage  of  the  current  at  the  neck  of  the  tooth  can  occur. 
The  exposed  surface  of  any  gold  or  other  metallic  filling  in  the 
tooth  should  be  coated  with  sandarac  varnish,  and  the  cavity, 
from  which  the  carious  matter  need  not  be  removed,  is  carefully 
dried  and  loosely  filled  with  cotton  saturated  with  the  obtunding 
solution. 

The  platinum  point  of  the  anode  is  covered  with  a  light  layer 
of  cotton  or  lint  which  is  dipped  into  the  obtunding  mixture. 

The  cathode  is  attached  to  the  left  wrist  of  the  patient,  and  its 
metallic  surface  prevented  from  coming  in  contact  with  the  skin 
38  - 


594  DENTAL  MEDICINE. 


by  means  of  lint  or  cotton  saturated  with  a  solution  of  chloride 
of  sodium.  All  being  ready,  the  point  of  the  anode  is  inserted  m 
the  cavity  in  contact  with  the  cotton  loosely  filling  it,  and  the 
switch  is  placed  on  the  first  contact  point  of  the  instrument,  and 
then  slowly  over  the  contacts  until  the  patient  exhibits  some  in- 
dication that  the  current  is  felt.  The  switch  should  be  retained 
at  such  a  contact  until  the  sensation  subsides,  when  the  resistance 
of  the  controller  should  be  gradually  lessened.  This  procedure 
is  continued  as  long  as  no  pain  is  felt,  when  the  switch  may  be 
more  rapidly  moved,  and  if  no  sensation  is  experienced,  it  may 
then  be  concluded  that  the  anaesthesia  is  complete.  The  switch 
is  then  moved  back  to  the  zero  point,  and  the  operation  on  the 
tooth  commenced. 

The  time  required  to  produce  anaesthesia  varies  from  eight  to 
fifteen  minutes,  although  a  longer  time  may  be  necessary  when  the 
dentine  is  very  dense. 

The  effect  is  better  when  the  application  is  made  directly  to  the 
carious  matter  in  the  cavity;  and  the  deeper  the  cavity  and  the 
nearer  approach  to  the  pulp  indicates  a  less  degree  of  voltage. 
The  removal  of  the  anode  while  the  current  is  on  and  before  the 
anaesthesia  is  complete,  causes  great  discomfort  to  the  patient,  and, 
hence,  should  be  avoided. 

The  appliances  for  bleaching  discolored  teeth  by  cataphoresis 
are  the  same  as  those  required  for  obtunding  the  hypersensitive- 
ness  of  dentine.  The  agents  employed  are  a  25  percent,  aqueous 
solution  of  peroxide  of  hydrogen,  the  ethereal  solution  opposing 
too  great  resistance  to  the  current. 

The  25  per  cent,  aqueous  solution  of  peroxide  of  hydrogen  is 
readily  made  by  shaking  together  in  a  test  tube  one  volume  of 
water  and  two  volumes  of  25  per  cent,  pyrozone.  The  peroxide 
dissolves  in  the  water,  and  the  ether  of  the  pyrozone  is  evapo- 
rated by  heat.  The  ethereal  solution  of  peroxide  of  hydrogen 
opposes  too  much  resistance  to  the  current.  Adding  a  small 
quantity  of  acetate  of  sodium  or  sulphate  of  sodium  will  facilitate 
the  passage  of  the  current  through  the  aqueous  solution  of  the 
peroxide  of  hydrogen. 

The  application  of  the  current  is  the  same  as  in  the  treatment 


CATAPHORESIS.  595 


of  hypersensitive  dentine,  the  tooth  cavity  being  filled  with  cotton 
saturated  with  the  bleaching  solution. 

A.  I.  F.  Buxbaum,  M.D.,  D.D.S.,  gives  the  following  as  his 
experience  in  the  use  of  cataphoresis  :  ''  Cocaine  applied  cata- 
phorically  has  been  proven  to  have  no  systemic  effects,  but  is  en- 
tirely local  in  its  action.  Apply  cocaine  by  cataphoresis  to  a 
central  incisor,  and  the  adjoining  central  or  lateral  will  be  as  sen- 
sitive as  if  no  application  had  been  made.  I  can  say,  however, 
from  my  practical  experience,  that  the  gum  immediately  sur- 
rounding the  anaesthetized  tooth  is  less  sensitive  than  normal. 
It  has  also  been  my  observation  that  when  a  pulp  is  completely 
anaesthetized,  that  tooth  takes  on  the  appearance  of  a  devitalized 
tooth, — namely,  the  tooth  becomes  darker;  and  when  drilled, 
seems  dry  (pulverizing,  so  to  speak),  the  dentine  giving  off  the 
odor  of  dead  bone  when  cut  or  filed.  I  have  also  observed  that 
any  slight  oozing  of  blood  from  the  gum  immediately  surround- 
ing the  tooth  to  be  anaesthetized  stops  upon  using  cataphoresis. 
To  test  the  power  of  cataphoresis  I  have  used  a  red-hot  instru- 
ment over  a  pulp  scarcely  covered  with  a  thin  layer  of  dentine, 
and  no  response  was  given  ;  I  have  gone  further  and  drilled  into 
pulps  which  I  wished  to  devitalize,  and  in  some  cases  no  response 
was  made,  in  others  only  a  trifle.  Where  I  wish  to  devitalize  a 
pulp  by  means  of  an  arsenical  application,  and  do  it  painlessly,  I 
first  use  cataphoresis,  then  drill  into  the  pulp  and  apply  arsenic. 
The  greatest  objection  to  cataphoresis  has  been  the  time  con- 
sumed in  its  application,  which  at  first  occupied  anywhere  from 
30  to  40  minutes.  After  becoming  more  familiar  with  this 
method  I  was  able  to  cut  down  the  time  to  thirty,  twenty,  fifteen 
and  twelve  minutes,  according  to  the  patient  and  tooth.  I  am 
now  able  to  anaesthetize  in  fifteen,  twelve,  ten,  seven  and  five 
minutes.  The  duration  of  the  anaesthesia  varies  in  different 
cases,  lasting  from  one-half  to  six  and  eight  hours.  I  have  yet 
to  find  a  case  where  the  result  has  not  been  favorable.  The 
danger  of  cataphoresis  lies  not  in  its  application  to  the  patient, 
but  in  the  care  and  boldness  with  which  a  dentist  can  operate. 
If  a  dentist  be  careless  he  could  easily  penetrate  or  expose  the 
pulp.     Not  eliciting  any  pain,  he  might  be  careless  and  not  pro- 


696  DENTAL  MEDICINE. 

tect  the  pulp.  Another  great  advantage  found  in  cataphoresis  is 
all  freedom  from  pain  when  finishing  off  a  filling  with  disks, 
strips,  stones,  etc.  I  have  found,  the  larger  the  cavity  and  the 
softer  the  dentine,  the  more  readily  will  cocaine  be  transmitted." 
Electric  Units :  Ampere — the  unit  of  measurement  of  an  elec- 
tric current;  the  unit  of  strength.  Ampere-hour — a  unit  of 
electric  quantity  equal  to  one  ampere  flowing  for  one  hour ;  it  is 
the  equivalent  of  3600  coulombs.  Coulomb — the  unit  of  meas- 
urement of  electric  quantity  ;  the  quantity  of  electricity  that 
passes  during  one  second  through  a  conductor  having  a  resistance 
of  one  ohm,  with  one  volt  of  electro-motive  force.  Ohm — the 
unit  of  resistance.  Volt — the  unit  of  electro-motive  force,  or 
the  force  sufficient  to  cause  a  current  of  one  ampere  to  flow 
against  a  resistance  of  one  ohm.  Watt — the  unit  of  power. 
Unit  of  current — a  conductor  one  cm.  long  which,  if  bent  into 
an  arc  of  one  cm.  radius,  will  act  with  the  force  of  one  degree  on 
a  unit  magnet  pole  at  the  centre.  Dyne — the  unit  of  force. 
Farad — the  unit  of  electric  capacity.  Erg — the  unit  of  electric 
work.  Volt-ampere — the  unit  of  electric  work ;  the  amount  of 
pressure  developed  by  a  current  of  one  ampere  having  an  electro- 
motive force  of  one  volt.  Volt  coulomb — the  unit  of  electric 
work.  Weber — an  ampere.  Unit  of  work — the  erg.  Joule — 
the  unit  of  electric  energy.  Milliampere — one-thousandth  of  an 
ampere. 

ERUPTION  OF  THE  TEETH. 

TEMPORARY    TEETH. 

(The  inferior  generally  precede  the  superior  by  two  or  three  months.) 

Central  incisors 5  to  8  months,  . 

Lateral  incisors      7  to  10      «' 

First  molars 12  to  16      " 

Canines 14  to  20      '< 

Second  molars 20  to  36      " 

The  following  diagram,  by  Dr.  Louis  Starr,'  shows  the  group- 
ing, the  date  of  eruption  and  the  duration  of  \he  pauses  between 
the  appearance  of  each  group  of  temporary  teeth. 

*  Diseases  of  the  Digestive  Organs  in  Children,  Philadelphia,  1891. 


ERUPTION  OF  THE  TEETH. 


597 


The  numbers  i  to  5  indicate  the  groups  to  which  the  indi- 
vidual teeth  belong  and  their  order  of  appearance,  and  the  letters 
a  and  h  the  precedence  of  eruption  in  the  different  groups. 


EXPLANATION    OF    DIAGRAM. 

1.  I.  Between  the  fourth  and  seventh  months.     Pause  of  3  to  9  weeks. 

2.  2.  2.  2.  Between  the  eighth  and  tenth  months.     Pause  of  6  to  12  weeks. 

3-  3-  3-  3-  3-  3-  Between  the  twelfth  and  fifteenth  months.     Pause  until  the 
eighteenth  month. 

4.  4.  4.  4.  Between  the  eighteenth  and  twenty-fourth  months.     Pause  of  2  to 
3  months. 

5.  5.  5.  5.  Between  the  twentieth  and  thirtieth  months. 


PERMANENT  TEETH. 


First  molars  . 
Central  incisors 
Lateral  incisors 
First  bicuspids 


5  to    6  years. 

6  to    8     " 

7  to    9     " 

9  to  ID      "     _ 


Second  bicuspids  10  to  12  years. 
Canines  .    .     .    .  11  to  13     " 
Second  molars    .  12  to  14     " 
Third  molars  .    .  17  to  21     <« 


AUTHORITIES  CONSULTED. 


Pharmacopoeia  of  the  United  States. 

Bartholow's  Materia  Medica  and  Therapeutics. 

United  States  Dispensatory. 

National  Dispensatory. 

Blakiston's  Physician's  Visiting  List. 

Biddle's  Materia  Medica. 

British  Pharmacopoeia. 

American  Journal  of  Medical  Sciences. 

London  Lancet. 

British  Medical  Journal. 

Stille's  Therapeutics  and  Materia  Medica. 

Taylor  on  Poisons. 

Tanner  on  Poisons. 

Wood's  Therapeutics,  Materia  Medica  and  Toxicology. 

Medical  Record. 

Ure's  Dictionary. 

Therapeutic  Handbook  of  the  United  States  Pharmacopoeia. 

Universal  Cyclopaedia — A.  McLane  Hamilton. 

Compendium  of  Medical  Science. 

American  Journal  of  Dental  Science. 

Dental  Cosmos. 

Dental  Register. 

Ohio  State  Journal  of  Dental  Science. 

Garretson's  Oral  Surgery. 

Tanner's  Index  to  Diseases. 

Pareira's  Materia  Medica  and  Therapeutics, 

American  System  of  Dentistry. 

Western  Dental  Journal. 

Items  of  interest. 

Dental  Review. 

International  Dental  Journal. 

Therapeutic  Gazette. 

Quain's  Dictionary  of  Medicine. 

Shoemaker's  Materia  Medica  and  Therapeutics. 

Turnbull's  Artificial  Anaesthesia. 

Gould's  Medical  Dictionary. 

Duane's  Medical  Dictionary. 

Dunglison's  Medical  Dictionary. 

Simon's  Chemistry, 

Potter's  Mat.  Med.,  Phar.  and  Therapeutics. 

Hare's  Practical  Therapeutics. 

Schleif's  Mat.  Med.  and  Therapeutics. 

Tirard's  Med.  Treatment  of  Diseases  and  Symptoms, 

Bruce's  Treatment  in  Practical  Medicine. 

Cushney's  Pharmacology  and  Therapeutics. 

Hall's  Chemistry  and  Metallurgy  Applied  to  Dentistry, 

Attfield's  Chemistry. 

Park's  Surgery. 

599 


INDEX  TO 
DISEASES  AND  DENTAL  FORMULARY. 


PAGE 

ABNORMAL  DENTITION' 148,  174 
Abnormal  Sensitiveness  of  Dentine 174 

Abraded  Surface  of  Mucous  Membrane  of  Mouth 212,436 

Abrasion  of  Teeth 175,  467 

Abrasions  by  Artificial  Dentures 212,  244,  300,  522 

Abrasions  of  Lips  and  Nostrils 212,  571 

Abscess 39,  127,  135,  248,  350,  539,  581 

of  Antrum 154,296,401,411,493,581 

Abscess,  to  abort 248,  441 

Abscess,  Maxillary 154,  581 

Abscesses,  Opening  of 183 

Absorption  of  Process  and  Recession  of  Gum 178 

Access  to  Root-Canals 235,  566 

Acidity  and  Pyrosis 306 

Acute  Inflammation  of  Dental  Pulp 173 

Acute  Inflammation  of  Mucous  Membrane  and  Gums 518 

Acute  Periodontitis 193 

Acute  Tonsilitis • 225 

After-pains  of  Tooth-Extraction 150,  221,  277,  320,  333,  346,  466,  467 

Alkaline  Gargle 455,  551 

Alveolar  Abscess 152,153,296,373,374,422,442,504,563 

Hemorrhage 150,245 

Pyorrhoea  .  168,  212,  219,  221,  225,  235,  237,  239,  300,  350,  376,  385,  401, 
422,  424,  441,  442,  454,  467,  505,  506,  541,  565,  566,  578 

Ulceration    .  ■ 155 

Analgesic  and  Anodyne 289,  290 

Anaemia  112 

Anaesthetics,  General 79,  136,  249,  337,  389,  472 

Local 79,210,248,276,277,294,320,332,333,335,459,512, 

556,  566,  571 

Anodyne  Lotion 320,  401,  424 

Antifebrin,  Prescription  for 193 

600 


INDEX  TO  DISEASES  AND  DENTAL  FORMULARY.        601 

PAGE 

Antiseptic  Bath  for  Instruments 276 

Antiseptic  Dentifrice 221 

Gargle  or  Mouth  Wash 137,  209,  212,  220,  276,  467,  506,  563 

Lotion  or  injection 219,  220,  235,  401,  424 

Oils 386 

Solution  for  Washing  or  Spraying  Wounds 212,220 

Antrum,  Suppuration  of .    .    .     • 154 

Aphthae 167,  227,  239,  240,  337,  382,  449,  524,  553 

'Aphthous  Ulcerations  (See  Aphthae) 212,416,551,553 

Aqua  Fortis 228 

Arsenical  Necrosis 157,  204 

Stomatitis 204 

Arsenical  Poisoning,  Symptoms  of 197 

Astringent  Dentifrice 243 

Lotion,  Gargle  or  Mouth  Wash  .    .    .    .    .  226,  244,  245,  300,  447,  468,  506 
Astringent  and  Antiseptic  Gargle 209,  219,  276 


B 


LACK'S  Antiseptic  Dressing  for  Pulp  Canals  and  Abscesses 387 

Bleaching  Discolored  Teeth 180,  245,  315,  507,  533,  552,  553 

Blood  Poisoning  ....'. 115,  183,  184 


Boils 


459 


Boulton's  Preparation 221,  440 

Bruises 248,  304 

Burns 235,  299 

Burnett's  Disinfecting  Fluid 576 

CALAHAN'S  METHOD 174,  238 
Campho-Phenique  Dentifrice 317 

Canal  Dressing 434 

Cancerous  Tumors 162,  167 

Calcic  Inflammation  of  Gums 183 

Calcification  of  Pulp 174 

Cancrum  Oris    ....        162,  194,  229,  306,  316,  382,  528,  581 

Capping  for  Exposed  Pulps 212,  558 

Carbolized  or  Carbolate  of  Potash  for  Alveolar  Pyorrhoea,  etc 218 

Styptic : 221 

Caries  of  Maxillary  Bones 145,  230,  237,  239,  382 

Caries  of  Teeth 182 

Catarrhal  Stomatitis 160 

Chapin   A.  Harris'    Dentifrice 537 

Chapped    Hands   and  Lips 212,  317,  518 

Chemical  Bleaching  of  Teeth 180 

Chilblains 221,  240 

Chloroform  Narcosis 287,  344 

Cholera  Infantum 306 


602        INDEX  TO  DISEASES  AND  DENTAL  FORMULARY. 

PAGE 

Chronic  Abscesses    and  Ulcers 152,  245,  416,  539,  581 

Alveolar  Abscesses,  Ulcerations,  etc 152,  416,  441 

Inflammation  of  Gums  and  Mucous  Membrane 227 

Inflammation  of  Dental  Pulp 173 

Inflammation 129 

Citroline    Dentifrice 380 

Cleft  Palate 162 

Cocaine,  To  make  Solutions  or  Preparations  of 16,  362 

Collyrium 108,  518,  551 

Condylomata 428 

Convulsions  of  Dentition 148,  321 

Counter-irritation 135,  322 

DANGERS  of  Anaesthesia 261 
Dental  Caries 182 

Exostosis,  or  Hypercementosis 176 

Dental  Periostitis  (See  Periodontitis). 

Dentifrices 221,  243,  317,  348 

Dentigerous    Cysts 163 

Denudation,  or  Erosion 177 

Deodorizers  of  Iodoform 433 

Detergent  Mouth  Wash  or  Gargle 536,  551 

Devitalizing  Pulps  of  Teeth 199,  205,  207,  433,  467,  563,  583 

Diarrhcea  of  Dentition 148,  239,  306,  428 

Diarrhoea  and  Vomiting 433 

Difficult  Teething 363 

Digestive  Stimulation  in  Alveolar  Pyorrhoea 348 

Diphtheritic  Conditions 503 

Discolored  Teeth  (See  Bleaching  Teeth). 

Disease  of  Antrum 296 

Diseases  of  Dental  Pulp  ..        172 

Disinfect   Softened  Dentine 424 

Disinfectant  Mouth  Wash  or  Gargle 220,  235,  528 

Disinfectant  for  Carious  Dentine       351,443 

Disinfecting  Instruments 588 

Dislocation  of  Jaw 164 

Disordered  Digestion 306 

Dressing  for  Children's  Teeth 221 

Dressing  for  Root  Canals,  Abscess,  etc 221 

Dry    Mouth 220 

Dysuria  of  Difficult  Dentition 456 

EARACHE  of  Dentition 345 
Ecchymosis 300 

Eczema  212,  299 

Edentulous   Neuralgia 176 


INDEX  TO  DISEASES  AND  DENTAL  FORMULARY.        603 

PAGE 

Effervescing    Powders 548 

Electro-Magnetism 34,  267 

Emollient  and  Antiseptic  Gargle 235 

Enlarged   Glands 434,  438 

Epithelioma      167 

Epulis 167 

Erosion   of  Teeth 177,  450 

Erythema 544 

Excessive  Sweating  of  the  Hands 442 

Exostosis,    Dental 176 

Exposed  Pulps 320,  333,  362,  466 

Exudation 123 

FACIAL  Neuralgia 193,  301,  302,  311,  459,  466,  539,  572,  574 
Paralysis 166 

Fainting 187 

Faught's  Treatment  of  Arsenical  Necrosis 204 

Febrile  Excitement  of  Dentition 428 

Felons 459 

Fetid  Perspiration 220,  528 

Fetor  of  Breath •     ...  315,  337,  563 

Fevers   of  Children 193 

Fissured  Tongue 212,  550,  551 

Flagg's    Devitalizing    Mixture 205 

Flexible  Crystallin 368 

Follicular  Stomatitis  and  Ulceration 167 

Foul  and  Fetid  Indolent  Ulcers 332 

Fracture   of  Alveolar  Process 157 

of  Jaw 165 

Fungous  Growths  and  Suppurating  Surfaces 173,  441 

Fungous  Growth  of  Pulp 173 

GALVANO-CAUTERY      30,  34 
Gangrene      141 

Gangrene  of  Mouth  (Cancrum  Oris)    .    .  162,  227,  306,  316,  337,  382, 

528,  581 

Garretson's    Devitalizing    Mixture 205 

Germicide    Mouth    Wash 563 

Gingivitis 159,  i6o,  447 

Glycerite  of  Borate  of  Sodium 550 

Glyceritum  Sodii  Boratis 550 

Glycerole   of  Thymol    Preparation 563 

Gum  Polypi 566 

Gums,  Soft  and  Spongy 219 

Irritation  of 364 

Gutta    Percha   Solution 445 


604        INDEX  TO  DISEASES  AND  DENTAL  FORMULARY, 

PAGE 

HARE-LIP 165 
Harlan's    Devitalizing    Mixtures 206 

Harris,  C.  A.,  Mouth  Wash 537 

Hectic  Fever 128 

Hemorrhage  from  Extraction  of  Teeth    .    .    .  150,  225,  226,  246,  325-,  407,  408 

Hemorrhage   from   Lancing  Gums ....  408 

Hemorrhage   from    Constitutional  Vice 561 

Herbst's  Obtundent 356 

Herpes  Zoster  of  Mouth  and  Gums 181 

Hyperemia Ill 

Hypercementosis 176 

Hypersensitive  Dentine  (See  Sensitive  Dentine)  .    .  39,  158,  174,  335,  363,  364 

Hypertrophy  of  Gums 167,  565 

of  Alveolar   Processes 176 

of  Tonsils 225 

Hypnotic 333,  334,  569 

IMPACTED  Tooth 163 
Incompatibility 35 

Indigestion 306,  500 

Indolent  Ulcers  of  Mouth 194 

Infantile  Diarrhoea,  during  Dentition 493,  494 

Infantile  Diarrhoea  from  Reflex  Nervous  Impressions 522 

Infantile    Bilious  Diarrhoea 455 

Mucous  Diarrhoea 455 

Infantile    Paralysis  during  Dentition 179 

Inflamed  and  Ulcerated    Gums 225,  416,  447,  577 

Inflamed  Fauces  and  Throat 194,  280,  296,  526 

Mucous  Membrane  and  Gums  .  191,  225,  243,  244,  280,  296,  3C0,  518,  524, 

525.  526 

Inflammation Ill 

of  Gums  after  Extraction  of  Teeth 518,524 

of  Mouth,  Syphilitic 161,  223,  524 

Spontaneous 115 

traumatic  or  idiopathic 115 

with  Special  Reference  to  the  Mucous  Membrane  of  the  Mouth  .111 

Inflammatory    Fever 122,  128 

Inhalation  in  Syphilitic  Ulcerations 220 

Injections,  Stimulant  and  Antiseptic 219,  220 

Internal  Astringent  in  Hemorrhagic  Affections  and  Dental  Hemorrhage  .    .  225 

Iodoform,  Deodorizing  of 433 

lodol,   Topical  Application  of 436 

Irritation 113 

of  Teething  and  of  Gums 148,  172,  363,  364 

of  Pulp   of  Tooth 172 


INDEX  TO  DISEASES  AND  DENTAL  FORMULARY.        605 

PAGE 

Ischemia 113 

Itcliing   of  Inflamed  Surfaces 467 

of  the  Skin 220 


K 


IRK'S  Devitalizing  Mixture '205 

Method  of  Bleaching  Teeth 507,  508,  552,  553 


LEAD    Poisoning 158 
Local  Anesthetic  (Bethel's) 210 

Local  Anaesthetics,  210,  248,  276,  277,  292,  320,  332,  333,  335,  346,  362,  363, 

364,411,459,  512,556,  566,  571 

Loose  Teeth  and  Inflamed  Gums 244 

Lotion  for  Soft  and  Spongy  Gums,  and  Loose  Teeth 219,  244 


MALIGNANT   Ulcerations 138 
Malignant    Tumors 163 

Maxillary   Abscess 156 

Medicated   Filling  Material 232 

Mercurial    Stomatitis 158,  239,  296,  337,  348,  442,  449,  524,  537 

Micro-organisms,  Effects   of 118 

Migraine 311 

Mild  Detergent  Gargle 536,  551 

Morbid  Growths 238 

Mouth  Wash,  Chapin  A.  Harris 537 

Washes 209,  220,  235,  424,  454,  467,  524,  536 

Mucous    Patches   of  Mouth 541 


NASAL  Polypus 166 
Nausea  from  Wearing  Dentures  and  Impressions 319,  364 

Necrosed  Teeth 178,  299 

Necrosis  of  Alveolar  Process 142 

Necrosis  of  the  Jaws 142,  164,  566 

Nerve  Paste 205,  207,  563,  580,  583 

Nervous  Cases 289,  291 

Neuralgia,  Edentulous 176 

Neuralgia  in  Superficial  Nerves 301,  302,  320 

Neuralgic  Headache 193 

Neuralgia,  176,  247,  248,  301,320,  3^^,  362,  363,  381,413,434,483,520,  522,  539 

from  Dental  Disturbance  ...  ....  176,413,539 

Neuralgic  Affections  of  the  Teeth 176,  248,  413 

Odontalgia 381 

Nitrate  of  Silver  in  Treatment  of  Dental  Caries 295 


606        INDEX  TO  DISEASES  AND  DENTAL  FORMULARY. 

PAGE 

OBTUNDING  Mixtures,  Local  Anaesthetics  (See  Local  Anaesthetics). 
Odontalgia,  39,   220,  221,  244,   247,   248,   276,  277,  280,  320,  332,  362, 
363.  368,  373.  413.  434.  459,  460,  467,  468 

Odontomes 177 

Offensive  Breath 443,  449,  528,  563 

Ointment  of  Iodoform  and  Eucalyptus 434 

Opening  Abscesses 183 

Organic  Defects  of  Structure 176 

Osseous  Tumors  of  the  Jaws 230 

Ossification  of  Dental  Pulp 174 

Overlying  Gum  of  Third  Molars 566 

Oxychloride  of  Zinc   Preparations 580 

Oxyphosphate  of  Zinc  Preparations 579 

PAIN  following  extraction  of  teeth  .    .  150,  221,  277,  320,  333,  346,  466,  467 
following  Separation  of  Teeth 317 

of  Difficult  Dentition 363 

Parasitic   Skin   Diseases 220,  240,  525,  539 

Periodontitis  or  Pericementitis 39,  150,  193,  248,  441,  442,  518,  549 

Perspiration  of  hands,  etc ,    .    .  235,  442 

Phagedenic   and  Sloughing  Ulcers , 449 

Phenol   Sodique   Preparations 546 

Phosphor    Necrosis 143,  157 

Pierce's  Devitalizing  Mixture 205 

Plethora 112 

Poisons  and  Antidotes 61 

Pulpitis 173,332,373,416,434,441 

as  a  Capping  in « 434 

Pulpless  Teeth 317,  433.  434,  S^T.  509 

Pulveris  Effervescentes 548 

Pus 125 

Putrescent  Pulps 174,411,416,433,442,528 

Pyemia 184 

Pyorrhoea  Alveolaris  (See  Formulae  under  Alveolar  Pyorrhoea) 168 

Pyrosis 306 


0 


UININE,  Disturbance  of  Nervous  System  from 289 


RECESSION   of  Gums 178 
Relaxation  of  Uvula 225 

Relaxed  Condition  of  Mucous  Membrane  of  Mouth  and  Gums     .    .  530 

Remove  Rust  on  Instruments 375 

Remove    Stain  of  Nitrate  of  Silver 296 

Resuscitation,  Methods  of 261 

Rheumatic  Pains,  Bruises,  etc 248 


INDEX  TO  DISEASES  AND  DENTAL  FORMULARY.         (]07 

PAGE 

Riggs'  Disease  (See  Alveolar  Pyorrhcea) i68 

Ringworm 305 

Robinson  Remedy 218 

Root  Canals  of  Abscessed  Teeth 401,  436,  521 

SALIVARY  Calculus,  after  Removal  of 244,412,515 
Salivation 158 

Sandarach  Solution  or  Varnish 544 

Scrofula 162 

Scorbutic  Gums 201,  228 

Scurvy      158,  194 

Sensitive   Dentine 39,  210,  276,  335,  362,  364,  466,  548,  572,  576 

Sensitiveness  after  Removal  of  Salivary  Calculus 244 

Septic   Fever 184 

Septicemia 183 

Shellac  Solution  or  Varnish 544 

Shock   and    Collapse 185 

Skin  Diseases 220 

Sloughing  and  Ill-conditioned  Ulcers 229 

Sloughing  and  Ulceration  from  topical  application  of  Arsenious  Acid    .  157,  204 

Soft  and  Spongy  Gums 219,  244,  547 

Soft,  White  Hands 448 

Softened  Dentine,  to  Sterilize 350,  424,  586 

Solvent  for  Calculi 566 

Sore  Throat 210,  225 

Sore  Moutli  of  Nursing  Women 210 

Sore  Mouth  of  Infants       416,  449 

Sterilizing  Cavities  in  Teeth 410 

Sterilizing  Instruments 276,  588 

Sterilizing  Softened  Dentine ■    .    .  350 

Stimulant  and  Antiseptic  Mouth  Wash  and  Lotion  .    .    .  210,  219,  447,  524,  536 

and  Antiseptic  Injection  .  219,220,401,424 

and  Anodyne  Lotion 320,401,424 

Stomatitis 159,  160,  276,  296,  337,  363,  524,  563 

Stomatitis  of  Dentition 210 

Styptics 368,  406 

Styptic  for  Bleeding  Gums 447,  547 

Superficial  Inflammations 276 

Suppurating  Pulps  of  Teetli  (See  Putrescent  Pulps) 174,500,563 

Wounds 212,  235,  524 

Suppuration 124 

Suppurative  Gingivitis 159 

Syncope   .     • 187 

Syphilitic  Teeth 177 

Ulceration  of  Mucous  Membrane  of  Mouth 161,  223,  524 


608        INDEX  TO  DISEASES  AND  DENTAL  FORMULARY, 

PAGE 

TEETH  deficient  in  Lime  Salts 314 
Teething  of  Children 363 

Thrush 166 

To  make  Solutions  of  Cocaine 20,  362 

To  prevent  injury  to  the  Teeth  by  acid  medicines 520 

To  render  the  Hands  Aseptic 590 

Thiersch's  Antiseptic  Solution 212,  235 

Tongue,  Indications  of 187 

Tonsilitis 225 

Topical  Applications 18,32,78 

Traumatic  Fever 122 

Trigeminal  Neuralgia 248 

Truman's  Bleaching  Method 180 

Devitalizing  Mixture 201 

Tumors  of  Gums •   .   434 

of  Jaws  .    .    .    .  * '. 162 

ULCERATED  Gums  and  Mucous  Membrane  .  227,  239,  245,  280,  300,  348, 
441,524,525 

Ulceration 138,  238,  416,  441 

Ulceration  and  Abrasion  of  Mouth 244,  280 

Ulceration  of  Mouth  and  Throat  ....  159,  227,  239,  245,  280,  296,  414,  528 

Ulcerous  Stomatitis 159,  227,  239,  245,  280,  296,  382,  414,  528 

Ulcers  of  Mouth 161,229,296,299,382,524,528 

over  Carious  Bone 230 

Syphilitic 161,  524 

Ulitis  (See  Inflammation  of  Gums,  etc.) 159 

Unerupted  Impacted  Tooth 163 

VAN  WOERT'S  Method  of  Treating  Abscessed  Teeth 508 
Varnishes,  Dental 436,  545 

Shellac 545 

Sandarach 544 

Venereal  Sore  Mouth  and  Throat 428 

Vomiting  and  Painful  Digestion  of  Teething  Children 306 


w 


ARTS,  Condylomata,  etc 235,  428 

Wash  after  Extraction  of  Teeth 348 

Wounds  Suppurating 212,  235,  524 


'INC  Preparations  for  Filling  Teeth 231,232,579,580- 


GENERAL  INDEX. 


ABBREVIATIONS,  22. 
Abies  Canadensis,  514. 
Abnormal  Dentition,  148,  174. 

Sensibility  of  Dentine,  174. 
Abrasion  of  Teeth,  175. 
Abscess,  127. 
Abscess  Alveolar,  152. 

of  Antrum,  154,  493. 

Cold,  128. 

Alveolar,  about  to  point  externally, 

153- 
Abscess,  Maxillary,  156. 
Abscesses,  Opening  of,  183.  . 
Absolute  Alcohol,  274. 
Absorbents,  98. 

Absorption  of  Alveolar  Process,  178. 
Acacia,  190. 
A.  C.  E.  Mixture,  343. 
Acetamid,  402. 
Acetate  of  Alumina,  280. 

of  Ammonia  Solution,  281. 

of  Lead,  516. 

of  Morphine,  463. 
Acetanilid,  191. 
Acetic  Acid,  193. 
Acids,  Organic,  77. 
Acids,  Inorganic,  77. 
Acidum  Aceticum,  193. 

Arseniosum,   195. 

Benzoicum,  207. 

Boricum,  210. 

Carbolicum,  212. 

Chromicum,  221. 

Cresylicum,  223. 

Gallicum,  223. 

Hydrobromicum,  226. 

Hydrochloricum,  226. 

Muriaticum,  226. 

39 


Acidum  Nitricum,  228. 

Nitricum  Dilutum,  228. 

Phosphoricum,  229. 

Salicylicum,  233. 

Sulphuricum,  235. 

Sulphuricum  Aromaticum,  236. 

Sulphurosum,  239. 

Tannicum,  240. 

Tartaricum,  244. 

Trichloroaceticum,  564. 
Aconite,  245. 
Aconitia,  247. 

Aconitine,  Duquesnel's,  245. 
Aconitum,  245. 
Action  of  Medicines,  12. 
Actol,  273. 
Acute  Inflammation   of   Dental   pulp, 

173- 
Administration  of  Anaesthetics,  255. 
After-pains  of  Tooth-extraction,  150. 
iEther,  249. 

'Ether  Sulphuricus,  249. 
Airol,  273, 
Alcohol,  274. 
Alcohol  Fortius,  274. 
Alkalies  and  Alkaline  Earths,  77. 
Alkaloids,   108. 
Aloe — Aloes,  277. 
Alteratives,  91. 

Alpha-oxynaphthoic  Acid,  471. 
Alum,  278. 
Alumen,  278. 

Exsiccatum,  278. 
Aluminse  Acetas,  280. 

et  ammonite  Sulphas,  279. 
Aluminii  et  Potassi  Sulphas,  279. 

Chloridum,  326. 

Sulphis,  279. 

609 


610 


GENERAL  INDEX. 


Alveolar  Abscess,  152. 

about  to  Point  Externally,  153. 
Alveolar  Hemorrhage,  242. 
Alveolar  Pyorrhoea,  168. 
Alveolar  Ulceration,  156. 
American  Hellebore,  572. 
Ammonia,  281. 
Ammonia  Alum,  278. 

Aromatic  Spirits  of,  282. 

Water,  281. 
Ammonii  Bromidum,  307. 
Ammonii  Carbonas,  2S3. 

Chloridum,  284. 
Ammonium,  281. 
Amygdalae  Dulcis,  486 
Amyl  Nitris,  287. 
Amylene,  285. 
Amylene  Hydrate,  285. 
Anaemia,  112. 
Anaesthesia  Pressure,  269. 
Anaesthetics,  79. 

Administration  of,  etc.,  255. 

Mixtures,  268,  343. 
Analgesics,  98. 
Anestile,  393. 
Aniline,  529,  584. 
Animal  Charcoal,  323. 
Anodynes,  98. 
Antacids,  92. 
Antemetics,  98. 
Anthelmintics,  97. 
Anthemis,  288. 
Anthridrotics,  99. 
Antifebrin,  191. 
Antikamnia,  289. 
Antilithics,  92. 
Antiperiodics,  99. 
Antipyretics,  99,  104.     * 
Antipyrine,  290. 
Antiseptic  Mixtures,  Dr.  Black's,  221, 

387- 
Solution,  212,  235. 
Antiseptic  and    Styptic  Cotton  Wool, 

292. 
Antiseptics,  99. 
Antiseptics,  Forms  of,  99. 


Antiseptics  in  Dental  Practice,  581. 
Antiseptics,  Incompatible,  588. 
Antispasmodics,  80. 
Antrum,  Disease  of,  154. 
Aphthaea,  167. 
Apothecaries'  Weight,  26. 
Approximate  Measurements,  24. 
Aqua  Acidi  Carbolici,  215. 
Aqua  Ammonia,  281. 

Camphora,  318. 

Chlori,  336. 

Cinnamomi,  350 

Creasoti,  372. 

Destillata,  292, 

Fortis,  228. 
Aralia  Spinosa,  574. 
Argenti  Nitras,  293. 
Aristol,  296. 
Aromatic  Bitters,  102. 

Spirits  of  Ammonia,  282. 
Aromatic  Sulphuric  Acid,  236. 
Arnica,  299. 
Arsenic,  Test  for,  206. 
Arsenical  Necrosis,  157,  204. 
Arseniosum  Oxidum,  195. 
Arsenious  Acid,  195. 
Artificial  Respiration,  261. 
Aseptol,  215. 
Astringents,  81. 
Atropine  Sulphas,  300. 
Atropine,  300. 
Aurum,  Terchloridum,  302, 
Avoirdupois  Weight,  26. 

BACTERIA,  118,  585. 
Baths,  108. 
Belladonnae  Folia,  303. 
Belladonna;  Radix,  303. 
Benzoate  of  Lithium,  450. 
Benzoate  of  Ammonium,  208. 
Benzoated  Lard,  208. 
Benzoic  Acid,  207. 
Benzoic  Sul])hide  of  Sodium,  304. 
Benzoyl-pseudo-tropein,  566. 
Bicarbonate  of  Potassium,  520. 
of  Sodium,  547. 


GENERAL  INDEX. 


611 


Bichloride  of  Mercury,  419. 
Bichloride  of  Mercury,  Test  for,  423, 
Bichloride  of  Methylene,  460. 
Biniodide  of  Mercury,  427. 
Bismuthi  Subnitras,  304. 
Black's  I,  2,  3  Mixture,  221,  387. 
Bleaching  Discolored  Teeth,  180,  245, 

315.  507.  533.  552.  553- 
Blenorrhetics,  89. 
Bloodletting,   General  and   Local,  34, 

134- 
Blue  Ointment,  426. 
Blue  Stone,  381. 

Mass,  426. 

Vitriol,  381. 
Bonwell's  Anaesthetic  Method,  271. 
Boracic  Acid,  210. 
Boric  Acid,  210. 

Lint,  211. 

Ointment,  21 1. 
Borate  of  Sodium,  549. 
Borax,  549. 
Boricine,  550. 
Boro-glyceride,  211. 
Borolyptol,  210. 
Boulton's  Preparation,  440. 
Bromides,  307. 
Bromide  of  Ammonium,  307. 

of  Calcium,  307, 

of  Lithium,  307, 

of  Sodium,  307. 

of  Camphor,  320. 

of  Ethyl,  393. 

of  Potassium,  521. 
Bromol,  308. 
Bromo-Phenol,  308. 
Brucine,  481. 

Burnett's  Disinfecting  Fluid,  576. 
Butyl-Chloral  Hydras,  380. 

C  ADMIT,  Sulphas,  309. 
Calcic    Inflammation   of  Gums 
and     Peridental    Membrane, 
183. 
Calcification  of  Dental  Pulp,  174, 
Calcii  Bromidum,  307. 


Calcii  Hypophosphis,  311,  514. 

Caffeine,  310. 

Calcii  Lithium,  307. 

Calcii  Phosphas  Pr^cipitatus,  514. 

Calcined  Magnesia,  337. 

Calcium,  313. 

Calendula,  312. 

Calisaya  Bark,  346. 

Calomel,  424. 

Calx,  313. 

Chlorata,  314. 
Campho-Phenique,  316. 
Camphoid,  319. 
Camphor,  318. 

Liniment,  318. 

Water,  318. 
Camphora,  318. 

Monobromata,  320. 
Camphorated  Tincture  of  Opium,  493. 
Cancrum  Oris,  162. 
Cantharidal  Collodion,  367. 
Cajuput  Oil,  487. 
Capsicum,  321. 
Capsules,  108. 
Carbo  Animalis  Purificatus,  323. 

Ligni,  323- 
Carbolate  of  Camphor,  219,  319. 
Carbolate  of  Cocaine,  511. 
Carbolate  of  Soda,  546. 
Carbolate  of  Sodium,  546. 
Carbolated  Cosmoline,  569. 
Carbolated  Camphor,  219,  319, 
Carbolic  Acid,  212. 

Ointment,  215. 

Water,  215. 
Carbolic  Acid,  Synthetic,  218. 
Carbolized  Cosmoline,  569. 
Carbon  Compounds,  77. 
Carbonate  of  Ammonium,  283. 

of  Lime,  376. 

of  Lithium,  450. 
Caries,  Dental,  182. 
Caries  of  Bone,  145. 
Carminatives,  102. 
Carvacrol,  324. 
Cassia  Bark,  349. 


612 


GENERAL  INDEX. 


Cassia  Oil,  350. 

Cataphoresis,  591. 

Cataplasms,  97,  108, 

Catarrhal  Stomatitis,  159. 

Catechu,  325. 

Cathartics,  85. 

Causes  of  Inflammation,  114. 

Caustic  Potassa,  5 1 8. 

Caustics,  102. 

Cauterants,  93. 

Cautery,  Actual  and  Potential,  95. 

Cayenne  Pepper,  321. 

Cerates,  109. 

Chalk  Mixture,  376. 

Chalk,  Prepared,  376. 

Chamomile,  288. 

Characteristic      Indications     of      the 

Tongue,  187. 
Chemical  Bleaching  of  Teeth,  180. 
Chinoline,  326. 
Chloral,  329. 

Hydras,  329. 
Chloral-Phenol,  331. 
Chloralamide,  333. 
Chloralum,  326. 
Chlorate  of  Potassa  Troches,  524. 

of  Potassium,  523. 
Chloretone,  334. 
Chloride  of  Aluminium,  326. 
Chloride  of  Ammonium,  284,  326. 

of  Ethyl,  390. 

of  Iron,  405. 

of  Lime,  314. 

of  Methyl,  328. 

of  Magnesium,  327. 

of  Zinc,  575. 

of  Zinc  Solution,  576. 

of  Tin,  327. 
Chlorinated  Lime — Chloride  of  Lime, 

314- 

Soda,  448. 
Chlorine,  336. 

Water,  336. 
Chlorinium,  336. 
Chloroform,  337. 
Chloroform- Cocaine  Narcosis,  287,  344. 


Chloroform-Morphia     Narcosis,      287, 

344- 
Chloroformum,  337. 

Purifactum,  338, 
Chloro-Percha,  445. 
Chromic  Acid,  221. 
Chronic  Inflammation,  129. 
Chronic  Inflammation  of  Dental  Pulp, 

173- 
Cicatrization,  140. 
Cinchona  Flava,  Pallida   and  Rubra, 

346. 
Cinnabar,  427. 
Cinnamomum,  349. 
Cinnamon,  349. 

Oil,  349. 

Water,  350. 
Citrate  of  Lithium,  450. 
Citrate  of  Caffeine,  310. 
Citroleine  Dentifrice,  380. 
Classification  of  Medicinal  Substances^ 

78. 
Cleft  Palate,  165. 
Clinical  Thermometer,  72. 
Clysters,  108. 
Cobalt,  207. 
Cocaine,  350. 

Dangers  of,  359. 
Carbon  Compounds,  77. 
Cocaine  Hydrochlorate,  35 1. 

Oleate,  363. 

Citrate,  355. 

-Chloroform  mixture,  344, 

-Chloroform  Narcosis,  344. 

Incompatibles,  361. 

Poisoning,  Treatment  of,  360. 
Cocainum  Phenylicum,  364. 
Cod-liver  Oil,  489. 
Colchicine,  365. 
Colchicum,  365. 

Cold  as  a  Local  Anaesthetic,  266. 
Collodion,  366. 
Collodium,  366. 

cum  Cantharide,  367. 

Flexile,  366. 

lodidum,  367. 


GENERAL  INDEX. 


613 


Collyria,  lo8. 

Coloring  Agents,  97. 

Colorless  Tincture  of  Iodine,  438. 

Compound    Syrup   of  the  Phosphates, 

513- 
Compound  Tincture  of  Iodine,  438. 
Compressed  Air,  269. 
Condy's  Fluid,  528. 
Confections,  108. 
Conium,  369. 
Constringents,  81. 
Convulsions  of  Dentition,  148. 
Corrosive  Chloride  of  Mercury,  419. 

Sublimate,  419. 
Coryl,  369. 
Cosmoline,  569. 
Counter-irritants,  ^;i,  102. 
Creasote,  370. 

Ointment,  373. 

Water,  372. 

Solidified,  372. 
Creasotum,  370. 
Creolin,  374. 
Cresol,  223. 
Cresylic  Acid,  223. 
Creta  Prseparata,  376. 
Croton-Chloral  Hydrate,  380. 
Crystallin,  368. 
Crystallin  Varnish,  368. 
Cupping,  35. 
Cupri  Sulphas,  381. 

DANGERS  of  Anaesthesia,  261. 
of  Cocaine,  359. 
Deadly  Nightshade,  303. 
Decimal  system  of  Weights  and  Meas- 
ures, 21. 
Decoction  of  White  Oak  Bark,  535. 
Decoctions,  108. 
Decoctum  Quercus  Albse,  535. 
Definition     of    Subjects     in    Materia 
Medica  and  Therapeutics,  17. 
of  Conditions  Associated  with  Dis- 
turbances of  Nutrition,  12. 
of   various    classes   of    Remedial 
Agents,  78. 


Demulcents,  96. 
Dental  Caries,  182. 

Treatment    of    with     Nitrate    of 
Silver,  295. 

Exostosis,  176. 

Materia    Medica    and  Therapeu- 
tics, 190. 

Periostitis,  150. 

Pulp,  Diseases  of,  173. 
Dentifrices,   108,   377,  378,  379,  380, 

444. 
Dentigerous  Cyst,  163. 
Dentition,  Abnormal,  148. 
Deodorized  Tincture  of  Opium,  493. 
Deodorizers,  103,  433. 
Dermatol,  306. 
Dessicatives,  98,  102. 
Detergents,  103. 

Devitalizing  Pulps  of  Teeth,  199. 
Dialysed  Iron,  405. 
Diaphoretics,  88. 
Diaphtherine,  494. 
Diarrhoea     of    Dentition,     148,    493, 

494- 
Diarrhoea,  Infantile  Bilious,  455. 
Diarrhoea,  Infantile,  Mucous,  455. 
Dichloride  of  Ethidene,  389. 
Digitalis,  383. 
Diluents,  103. 
Dilute  Acetic  Acid,  194, 
Diluted     Solution    of    Subacetate    of 

Lead,  517. 
Dimethyloxyquinizine,  290. 
Discutients,  103. 
Disinfectants,  103. 
Disinfecting  Instruments,  588. 
Dislocation  of  Lower  Jaw,  164. 
Distilled  Water,  292. 
Dithymol  Diodide  or  Biniodide,  296. 
Diuretics,  89. 

Doses  of  Medicines,  Table  of,  43. 
Doses,  Rules  for  Regulating,  30. 
Dover's  Powder,  492. 
Drainage,  135. 
Drastics,  86. 
Dried  Alum,  278. 


614 


GENERAL  INDEX. 


ECCRITICS,  78. 
Edentulous  Neuralgia,  176. 

Effervescing  Powders,  548. 

Electric  Units,  596. 

Electrical  Diffusion,  591. 

Electrical  Osmosis,  591. 

Electricity  for  Relieving  Pain  of  Ex- 
traction of  Teeth,  29,  34,  267. 
Methods  of  Applying,  267. 
as  a  Therapeutic   Means  in  Treat- 
ment of  Disease,  35. 

Electrolysis,  39. 

Electrolysis  for  Sensitive  Dentine  and 
Periodontitis,  39. 

Electro-Magnetism  for   Extraction    of 
Teeth,  40,  267. 

Electrozone,  384.  ' 

Electuaries,  108. 

Elementary  Substances,  Table  of,  73. 

Elixir  of  Vitriol,  235. 

of  Vitriol  and  Tannin,  242. 

Emetics,  83. 

Emmenagogues,  90. 

Emollients,  96,  103. 

Emulsions,  108. 

Enemata,  86,  108. 

En-epidermic  Method,  18. 

Epidermic  Method,  18. 

Endermic  Method,  18. 

Enzymol,  384. 

Epispastics,  93. 

Epithelioma,  167. 

Epsom  Salt,  456. 

Epulis,  167. 

Equivalents,  29. 

Ergot,  385. 

Erosion  of  Teeth,  177. 

Errhines,  104. 

Eruption  of  the  Teeth,  596, 

Escharotics,  93,  104. 

Essential  Oils,  386. 

Ether,  249. 

Ethidene  Dichloridum,  389. 

Ethyl     Chloride-Mono-Chlor     Ethane, 

390- 
Ethyl  Bromidum,  393. 


Ethylene,  497. 

Eucaine,  396. 

Eucalyptol,  398. 

Eucalyptus,  398. 

Euformal,  400. 

Eugenic  Acid,  488. 

Eugenol,  488. 

Eugenol-acetamid,  402. 

Europhen,  402. 

Euthymol,  400. 

Evacuants,  104. 

Excitants,  104. 

Exostosis,  Dental,  176. 

Expectorants,  104. 

Extraction  of  Teeth,  Pain  from,  150. 

Extracts,  108. 

Extractum  Gelsemii  Fluidum,  413. 

Krameriae,  447, 
Exudation,  123. 

FACIAL  Neuralgia  (See  Index  to 
Dental  Diseases,  etc.) 
Facial  Paralysis,  166. 
Febrifuges,  104. 
Ferri  Arsenias,  198. 
Ferri  Chloridum,  405. 
Ferrum,  404. 

Dialysatum,  405. 

Reductum,  406. 
Fever  of  Inflammation,  122,  128. 
Fillebrown's  Method  of  Administering 

Ether,  260. 
Fineness  of  Powder,  25. 
Flexible  Collodion,  366. 
Follicular  Ulceration,  167. 
Fomentations,  109. 
Formalide,  193. 
Formaline,  408. 
Formalin,  408. 

Forms  of  Antiseptics  for  Use,  99. 
Forms  of  Medicinal  Substances,  108. 
Fracture  of  Alveolar  Process,  157. 
Fracture  of  Lower  Jaw,  165. 
French    Decimal    System   of  Weights 

and  Measures,  27. 
Fused  Potassa,  518. 


GENERAL  INDEX. 


615 


Fungous  Growth  of  Pulp,  173. 
Fumigations,  109. 

GALLIC  ACID,  223. 
Galls,  224. 
Galvano-Cautery,  36,  40. 
Gangrene,  141. 
Gargles,  109. 
Galvanism,  32. 
Gaultheria,  41 1. 
Gelsemium,  412. 
Germicides,  105. 
Glacial  Acetic  Acid,  194. 
Glacial  Phosphoric  Acid,  231. 
Gluside,  413. 
Glutol,  410. 
Glycerin,  414. 
Glycerinum,  414. 

Boracis,  211,  550. 

Pepsini,  499. 
Glycerite  of  Borate  of  Sodium,  550. 

of  Carbolic  Acid,  215. 

of  Gallic  Acid,  225. 

of  Tannic  Acid,  243. 
Glycerites,  109,  414. 
Glyceritum  Acidi  Carbolici,  215. 

Acidi  Gallici,  224. 

Acidi  Tannici,  243. 

Sodii  Boratis,  550. 
Glycerols,  109. 
Gingivitis,  159. 
Glacial  Acetic  Acid,  194. 
Glycerite  of  Borate  of  Sodium,  550. 
Glycerite  of  Tannic  Acid,  243. 
Glycerole  of  Thymol,  562,  563. 
Glyco-Thymoline,  564. 
Glycozone,  416. 
Granulation,  124. 
Green  Iodide  of  Mercury,  427. 
Gum  Arabic,  190. 
Guaiacol,  374. 
Gutta  Percha,  444. 


H 


iEMATINICS,  90. 
Haemetics,  78. 


Haemostatics,  105,  407. 

Hamamelis,  418. 

Hands,  To  Render  White  and  Soft, 
448. 

Hare-Lip,  165. 

Harland's  Method  of  Treating  Al- 
veolar Pyorrhoea,  505. 

Hall's  (Marshall;  Ready  Method  in 
Asphyxia,  263. 

Healing  of  Ulcers,  140. 
■  Hectic  Fever,  128. 

Hematinics,  90. 

Hemetics,  78. 

Hemorrhage  Following  the  Extraction 
of  Teeth,  150,  225,  242,  249, 
407. 

Hemostatics,  105. 

Hemlock,  369. 

Herbst's  Obtundent,  356. 

Herpes  Zoster  of  Mouth  and  Gums, 
181. 

Hill's  Stopping,  445. 

Hoffman's  Anodyne,  251. 

Honey    of    Borate    of    Sodium,    211, 

550- 
Howard's    Method   of  Artificial    Res- 
piration and  Resuscitation,  264. 
Hirudo,  29. 

Hyderabad    Commission    on    Chloro- 
form, 340. 
Hydrargyri     Chloridum     Corrosivum, 
420. 

Chloridum  Mite,  424. 
Hydrargyrum,  416. 

cum  Creta,  426. 

lodidum  Viride,  427. 

lodidum  Rubrum,  427. 

Sulphidum  Rubrum,  427. 
Hydragogues,  85. 
Hydrate  of  Amylene,  285. 

of  Butyl  Chloral,  380. 

of  Chloral,  329,  380. 
Hydrate  of  Potash,  518. 
Hydrochlorate  of  Ammonia,  284. 

of  Morphine,  463. 

of  Eucaine,  396. 


616 


GENERAL   INDEX. 


Hydrochloric  Acid,  226. 
Hydrobromic  Acid,  226. 

Ether,  393. 
Hydrogen  Dioxide,  500. 

Peroxide,  500. 
Hydronapthol,  470. 
Hyperemia,  III. 
Hypercementosis,  176. 
Hypersensitive  Dentine,  148,  174. 
Hypersthenics,  105. 
Hypertrophy   of   Alveolar    Processes, 
176. 

of  Gums,  168. 
Hypnotics,  78,  98,  105,  334. 
Hypodermic  Injection,  32. 
Hypodermic  Method,  18,  32. 
Hypodermic  Syringe,  33,  357. 
Hypophosphites,  514. 
Hypophosphite  of  Lime,  311. 

of  Sodium,  514. 

IATROL,  428. 
Idiosyncrasy,  14. 
Impacted  Tooth,  163. 
Important   points   in    Diagnosing   Af- 
fections of  the  Mouth,  148. 
Incompatible  Antiseptics,  588. 
Incompatibility,  41. 
Infantile    Paralysis   during  Dentition, 

179. 
Inflammation  with   Special  Reference 
to  the  Mucous  Membrane  of  the 
Mouth,  III. 
Inflammation,  Symptoms  of,  114,  119. 
Causes  of,  114. 
Chronic,  129. 
Terminations  of,  130. 
Treatment  of,  131. 
of  Peridental  Membrane,  150. 
of  Dental  Pulp,  173. 
of     Mucous     Membrane    of    the 
Mouth,  Syphilitic,  161. 
Inflammatory  Induration,  129. 
Inhalents,  lOg. 
Injections,  109. 
Infusions,  109. 


Infusum  Capsici,  322. 
Ingluvin,  500. 

Inorganic  Materia  Medica,  77. 
Iodide  of  Potassium,  437. 

of  Zinc,  577. 
Iodine,  436. 

Tri-chloride,  441,  442. 
Iodized  Collodion,  368. 
Iodoform,  429. 

Vapor,  Use  of,  431, 
lodoformum,  429. 
lodol,  435. 
lodolum,  435. 
lodum,  436. 
Iridis  Rizome,  443. 
Iron  and  Preparations,  404, 
Irrigation,  135. 
Irritants,  93. 
Irritation,  113. 

of  Dental  Pulp,  172. 

of  Teething,  148. 
Ischsemia,  113. 

Isobutyl-ortho-cresol-iodide,  402. 
Isonandra  Gutta,  444. 
Issues  and  Setons,  95. 


J 


AMAICA  Dogwood,  515, 
Japanese  Camphor,  458. 


KALIUM-NATRIUM,  520. 
Kandol,  446. 
Kino,  449. 
Kirk's  Bleaching   Methods,  507,  508, 

552,  553- 
Krameria,  446. 
Kreoline,  374. 

LABARRAQUE'S  Solution,  448. 
Lacmus,  450. 
Lacto-Phosphate  of  Lime  Syrup,  513. 
Lanolin,  448. 
Laudanum,  492. 
Laughing  Gas,  472. 
Laxatives,  86,  105. 
Lead  Poisoning,  158,  517. 
Water,  517. 


GENERAL   INDEX. 


617 


Leeches,  34. 

Marshall  Hall's  Ready  Method,  263. 

Lenitives,  96. 

Matico,  457. 

Leopard's  Bane,  299. 

Maxillary  Abscess,  156. 

Lime,  313. 

Measurement  of  Medicinal  Substances, 

Liniment,  313. 

18. 

Water,  313. 

Measuring  Liquids  by  Drops,  25. 

Liniments,  109. 

Meadow  Saffron,  365. 

Linimentum  Calcis,  313. 

Medicated  Oxyphosphate  of  Zinc  Fill- 

Camphorse, 318. 

ings,  232. 

Saponis,  318. 

Meditrina,  457. 

Terebinthinse,  560. 

Menthol,  458. 

Liquefied  Nitrous  Oxide,  473. 

Mel  Boracis,  550. 

Liquid  Air,  269. 

Sodii  Boracis,  550. 

Liquor  Ammonii  Acetatis,  283. 

Mercury,  419. 

Calcis,  313. 

with  Chalk,  426. 

Ferri  Perchloridi,  405. 

Bichloride  of,  419. 

Ferri  Subsulpliatis,  406. 

Mercurial  Ointment,  426. 

Gutta  Percha,  445. 

Poisoning,  158. 

Plumbi  Subacetatis  Dilutus,  517. 

Stomatitis,  158. 

Potassii  Arsenitis,  195. 

Mercuric  Chloride,  420. 

Sodse  Chloratce,  448. 

Mercurous  Chloride,  424. 

Potassii  Permanganatis,  528. 

Meta-iodo-ortho-oxyquinoline  and  Sul- 

Zinci  Chloridi,  576. 

phonic  Acid,  451. 

Gutta  Percha,  445. 

Methyl  Chloride,  328. 

Listerian  Method,  loi. 

Methyl  Ether,  460. 

Listerine,  209. 

Methyl-Ethylic  Ether,  460. 

Lithium,  450. 

Methyl  Violet,  529. 

Lithii  Benzoas,  450. 

Methylene,  460. 

Lithii  Bromidium,  307. 

Methylene-blue,  584. 

Lithii  Carbonas,  450. 

Metric  System  of  Weights  and  Meas- 

Lithii Citras,  450. 

ures,  27. 

Lithii  Sahcylas,  450. 

Microcidin,  461. 

Lithontriptics,  92. 

Micro-Organisms,  Effects  of,  118. 

Litmus,  450. 

Mild  Chloride  of  Mercury,  424. 

Local  Anaesthesia,  266. 

Mistura  Amygdalse,  486. 

Bloodletting,  134. 

Mistura  Cretae,  376. 

Loretin,  451. 

"^  Mixed  Chloroform  Morphia  Narcosis 

Lotions,  109. 

344- 

Lunar  Caustic,  293. 

Mixtures,  109. 

Lysol,  452. 

Monobromated  Camphor,  320. 

Mono-Chlor-Ethane,  390. 

A /I  AGNESIA,  454. 

i  V  I     Magnesii  Chloridum,  327. 

Monsel's  Solution  and  Powder,  406. 

Morphia  and  Chloroform  Narcosis,  344. 

Magnesium  Hydrate,  455. 

Morphina,  461. 

Sulphas,  456. 

Morphinae  Acetas,  463. 

Marigold,  312. 

Hydrochloras  or  Murias,  463. 

618 


GENERAL   INDEX. 


Morphinae  Sulphas,  463. 
Morphine,  461. 

Narcosis,  344. 

Muriate  of  Ammonia,  284. 

of  Morphine,  463. 
Mouth  Washes,  109,  424. 
Mucilages,  109. 
Muriate  of  Morphine,  463. 
Muriatic  Acid,  226. 
Myrrh,  467. 
Myrrha,  467. 
Myrtle  Oil,  469. 
Myrtol,  469. 

NAPHTHALIN,  469. 
Napelline,  245. 
Naphthalene,  469. 
Naphtol,  470. 
Narcotics,  78. 
Nasal  Polypus,  166. 
Natural  Distribution  of  Remedies,  77. 
Nausea  from  Impression-Taking,  319. 
Nauseants,  83. 
Necrosis,  142. 
Necrosed  Teeth,  178. 
Necrosis  of  Alveolar  Process,  54. 

of  Bone,  164. 

of  Jaw,  164. 
Nfelaton's  Method  of  Resuscitation,  262. 
Nervines,  105,  557. 
Neuralgia,  Edentulous,  176. 
Neurotics,  78. 
Nitrate  of  Ammonia,  473. 

of  Potassium,  525. 

of  Silver,  293. 
Nitre,  525. 
Nitric  Acid,  228. 
Nitric  Oxide,  473. 
Nitrite  of  Amyl,  287. 
Nitrous  Oxide,  472. 
Nitrous  Oxide,  Action  and  Adminis- 
tration of,  475,  477. 
Nitrous  Oxide  and  Oxygen  combined, 

478. 
Nitrous   Oxide    and    Atmospheric  Air 
combined,  478. 


Nitrous  Powders,  526, 

Non-metals,  77. 
Nutritives,  105. 
Nux  Vomica,  481. 

OBTUNDING   Mixtures,   Use   of, 
33,  268. 
Odontomes,  177, 
Oil  of  Cassia,  350. 

of  Cajuput,  487. 

of  Camphor,  319. 

of  Cinnamon,  349. 

of  Cloves,  487. 

of  Eucalyptus,  398. 

of  Gaultheria,  411. 

of  Peppermint,  459. 

of  Pyrethrum,  530, 

of  Sanitas,  560. 

of  Sweet  Almonds,  486. 

of  Turpentine,  559. 

of  Vitriol,  235. 
Oils,  Essential,  386. 
Ointment  of  Carbolic  Acid,  215, 

of  Creasote,  373. 

of  Galls,  225. 

of  Tannic  Acid,  243. 

of  Vaseline,  571. 

of  Veratrine,  572. 
Ointments,  109. 
Oleate  of  Aluminum,  485. 

of  Arsenic,  485. 

of  Bismuth,  485. 

of  Cadmium,  486. 

of  Cocaine,  363. 

of  Copper,  485. 

of  Lead,  484. 

of  Mercury,  484. 

of  Nickel,  486. 

of  Silver,  486. 

of  Zinc,  484. 
Oleates,  Medicinal,  1 10,  483. 
Oleum  Amygdalse  Dulcis,  486. 

Cajuputi,  487. 

Camphorre,  319. 

Caryophilli,  487. 

Cinnamomi,  349. 


GENERAL    INDEX. 


619 


Oleum  Eucalypti,  398. 

Gaultheria?,  411. 

Morrhuje,  489. 

Sanitas,  560. 

TerebintliiriEe,  559. 
Opening  Abscesses,  183. 
Opium,  490. 

Organic  Defects  of  Structure,  176. 
Organic  Materia  Medica,  77. 
Origin  and  Characteristics  of  Pus,  125. 
Orris  Riiizome,  443. 

Root,  443. 
Orthoform,  494. 

Ossification  of  Dental  Pulp,  174. 
Oxide  of  Potassium,  518. 

of  Zinc,  578. 
Oxychloride  of  Zinc  Filling  Material, 

580. 
Oxyphosphate    of  Zinc    Filling   Mate- 
rial, 231,  232,  579. 

of  Zinc  Filling  Medicated,  232. 
Oxyquinaseptol,  494. 

PAIN  after  the  Extraction  of  Teeth, 
150,  221,  277. 
Passive  Hyperasmia,  112. 
Papain  or  Papaiva,  495. 
Paraacetphenitidine.  509. 
Paraform,  410. 
Paralysis,  Infantile,  179. 
Paraldehyde,  496. 
Paregoric  Elixir,  493. 
Pellitory,  529. 
Peppermint  Camphor,' 458. 
Pepsin,  499. 
Pepsinum,  499. 

Saccharatum,  499. 
Percentage  Solution,  Tables  for,  20, 
Perchloride  of  Iron,  405. 
Pericementitis,   150. 
Rental,  497. 
Periodontitis,  150. 
Permanganate  of  Potassium,  526. 
Peroxide  of  Hydrogen,  500. 
Peroxide  of  Hydrogen,  Test  for,  504. 
Peroxide  of  Sodium,  506. 


Peruvian  Park,  346. 

Petrolatum,  569. 

Petroleum  Ointment,  569. 

Pharmacology,  17. 

Pharmacy,  17. 

Phenacetine,  510. 

Phenalgin,  510. 

Phenate  of  Cocaine,  511. 

Phenate  of  Sodium,  217,  219,  546. 

Phenic  Acid,  212. 

Phenol,  212. 

Phenol-Camphor,  319. 

Phenol  Sodique,  217,  219,  546. 

Phenyl-Acetamide,  191. 

Phenyl  Ether  of  Salicylic  Acid,  543. 

Phenylic  Alcohol,  212. 

Phosphate  of  Lime,  514. 

Phosphate  of  Sodium,  514. 

Phosphates,  513. 

Phosphites,  513. 

Phosphorus,  229. 

Phosphorus  Necrosis,  144,  157. 

Phosphoric  Acid,  229. 

in  the  Anhydrous  State,  230. 
Pills,  no. 

Pilulas  Hydrargyei,  426. 
Pinus  Canadensis,  514. 
Piscidia,  Erythrina,  515. 
Pix  Canadensis,  515. 
Plasters,  no. 
Plethora,  112. 
Plumbi  Acetas,  516. 
Poisons,  61. 

Symptoms,     and     Antidotes     for, 
Acids,  Mineral,  61. 

Aconite,  62. 

Alkalies,  62. 

Antimony,  62. 

Arsenious  Acid,  62. 

Argenti  Nitras,  62. 

Atropine,  62. 

Belladonna,  63. 

Cannabis  Indica,  63. 

Cantharides,  63. 

Carbolic  Acid,  63. 

Chloral,  64. 


620 


GENERAL   INDEX. 


Poisons,  Chlorine  Water,  63. 

Chloroform,  64. 

Cocaine,  360. 

Conium,  64. 

Copper,  Sulphate  of,  65. 

Corrosive  Sublimate,  64. 

Creasote,  65. 

Croton  Oil,  65. 

Digitalis,  65. 

Hydrocyanic  Acid,  65. 

Hyoscyamus,  66. 

Iodine,  66. 

Lead  Salts,  66. 

Mercury,  66. 

Morphine,  67. 

Nux  Vomica,  66. 

Opium,  67. 

Oxalic  Acid,  67. 

Phosphorus,  67. 

Potash  and  Soda  Salts,  67. 

Silver,  Nitrate  of,  67. 

Stramonium,  63. 

Strychnine,  67. 

Tobacco,  68. 

Zinc  Salts,  68. 
Poke  root,  572. 
Polypus,  Nasal,  166. 
Posological  Tables,  43. 
Potassa  Alum,  279. 

Caustica,  518. 

Cum  Calce,  519. 
Potassii  Bicarbonas,  520. 
Potassii  Bromidum,  521. 

Chloras,  423. 

lodidum,  437. 

Nitras,  525. 

Permanganas,  526. 
Potassium    and    Sodium     Compound, 

520. 
Poultices,  97,  no. 
Pulpitis,  173. 

Powdered  Subsulphate  of  Iron,  406. 
Powders,  no. 
Precipitated  Chalk,  376. 

Phosphate  of  Lime,  514. 
Prepared  Chalk,  376. 


Pressure  Anaesthesia,  269. 

Preventive  Measures  against  Dangers 

of  Anaesthesia,  261. 
Preventive  or  Prophylactic  Treatment, 

18. 
Prickly  Ash,  574. 
Prince's  Method  of  Treating  Alveolar 

Abscess,  504. 
Protectives,  103. 
Protiodide  of  Mercury,  427, 
Protoxide  of  Nitrogen,  472. 
Pulp  Devitalization,  580. 
Pulse,  the,  68. 

Variations  in  frequency  of,  69. 
Pulvis  Ferri  Subsulphatis,  406. 

Ipecac  et  opii,  492. 
Purgatives,  86,  105. 
Purified  Animal  Charcoal,  323. 
Pus,  125. 
Pyemia,  184. 
Putrescent  Pulps,  174. 
Pyoctanin,  529. 
Pyorrhoea,  Alveolar,  168. 
Pyrethrum,  529. 
Pyrophosphate  of  Sodium,  5 14. 
Pyrozone,  531. 

QUERCUS,  Alba,  535. 
Quicksilver,  419. 
Quillaia  Bark,  535. 
Quillaia  Saponaria,  535. 
Quininse,  347,  537. 
Sulphas,  537. 
Quinine,  347,  537. 
Quinoline,  326. 

RAPID   Breathing  as   a  Pain  Ob- 
tunder,  271. 
Raymond's  Method  of  preparing  and 

applying  Cocaine,  357 
Recession  of  Gums,  178. 
Rectified  Myrtol  Oil,  469. 
Red  Sulphuret  of  Mercury,  427. 
Reduced  Iron,  406. 
Refrigerants,  106. 
Reinsch's  Test  for  Arsenic,  207. 


GENERAL   INDEX. 


621 


Remedies,  Natural  Distribution  of,  77. 

Silver  Sulpho-Carbolate,  546. 

Resolvents,  106. 

Silver  Sulpho-Phenate,  546. 

Resorcin,  539. 

Silver  Lactate,  273.            ^ 

Respiration  at  Various  Stages,  71. 

Soap  Liniment,  318. 

Restoratives,  106. 

Sodae  Arsenias,  198. 

Resuscitation,  Methods  of,  261. 

Sodse  Phenas,  546. 

Rhatany,  446. 

Sodii  Bicarbonas,  547. 

Rheum,  541. 

Boras,  549. 

Rhigolene,  542. 

Bromidum,  307. 

Rhubarb,  541. 

Sodii  Hypophosphis,  513, 

Riggs'  Disease,  168. 

Phosphas,  514. 

Robinson  Remedy,  218. 

Pyrophosphas,  5 14. 

Rubefacients,  93. 

Salicylas,  551. 

Rule  for  Finding  Amount  of  a  Drug  in 

Sulphis,  552. 

a  Given  Percentage  of  Solution, 

Sodium  Dioxide,  506. 

22, 

Sodium  Peroxide,  506, 

Rules  for  Administering  Anresthetics, 

Sodium  Silico-Fluoride,  553. 

255- 

Solubility  of  Chemicals  in  Water  and 

for  Regulating  Doses,  30. 

Alcohol,  74. 

Solution  of  Acetate  of  Ammonia,  283. 

Q  ACCHARATED  Pepsin,  499, 
v3     Sal  Ammoniac,  284. 

of  Chlorinated  Soda,  448. 

of  Chloride  of  Zinc,  577. 

Salicylic  Acid,  233. 

of  Gutta  Percha,  445. 

Salicyl  Resorcin  Ketone,  540. 

of    Permanganate    of    Potassium, 

Salicylate  of  Lithium,  450. 

528. 

Salicylate  of  Sodium,  551. 

of  Subsulphate  of  Iron,  406, 

Salipyrine,  234. 

Soporifics,  98. 

Salivation,  158. 

Sozoiodol,  554. 

Salol,  543. 

S.  Am.  Soap  Tree  Bark,  535. 

Saltpetre,  525. 

Spastics,  83. 

Sandaraca,  544. 

Spirit  of  Camphor,  318. 

Sandarach,  544. 

of  Chloroform,  344 

Sanitas,  560. 

of  Cinnamon,  350. 

Sanitol,  561. 

of  Nitrous  Ether,  251. 

Scarifications,  35. 

of  Mindererus,  283. 

Scurvy,  158. 

Spinants,  83. 

Scrofula,  162. 

Spirits,  III. 

Sedatives,  83,  98. 

Spiritus  Ammonise  Aromaticus,  281. 

Sensitive  Dentine,  148,  174. 

yEtheris  Compositus,  251. 

Septicemia,  183. 

Athens  Nitrosi,  251. 

Sesquicarbonate  of  Sodium^  547. 

Camphorse,  318. 

Septic  Fever,  184. 

Chloroformi,  344. 

Setons  and  Issues,  34. 

Cinnamomi,  350. 

Shellac,  544. 

Frumenti,  274. 

Shock  and  Collapse,  185. 

Vini  Gallici,  274. 

Sialagogues,  106. 

Stannum  Chloridum,  327. 

622 


GENERAL    INDEX. 


Stearoptenes,  iii. 
Sterilizing  Instruments,  588. 
Stimulants,  82. 
Stomachics,  82. 
Stomatitis,  159. 

Aphthous,  167. 

Catarrhal,  159,  160. 

Gangrenous,  162. 

Parasitic,  166. 

Ulcerous,  160. 

Mercurial,  158. 

Syphilitic,  161. 

a  Simple  Form  of,  159. 
Strophanthin,  555. 
Strophanthus,  555. 
Strychnine,  481. 
Strychninae  Sulphas,  482. 
Styptic  Colloid,  242. 

Cotton,  243,  292. 
Styptics,  107,  242. 
Subnitrate  of  Bismuth,  304, 
Subsulphate  of  Iron,  406. 
Sugar  of  Lead,  516. 
Sudorifics,  88. 
Sulfonal,  556. 
Sulphate  of  Atropine,  300, 

of  Cadmium,  309. 

of  Copper,  381. 

of  Magnesium,  456. 

of  Morphine,  463. 

of  Quinine,  347,  537 

of  Strychnine,  482. 

of  Zinc,  580. 
Sulphite  of  Soda,  552. 
Sulpho-Carbolates    of   Zinc,    Sodium, 
Potassium,      Magnesium,     Cal- 
cium and  Quinine,  216. 
Sulpho-Carbolic  Acid,  215. 
Sulpho-Carbolate  of  Zinc,  577. 
Sulphophenol,  215. 
Sulphonal,  556. 
Sulphuric  Acid,  235, 

Ether,  249. 
Sulphurous  Acid,  239. 
Suppositories,  ill. 
Suppurants,  94. 


Suppurating  Teeth,  174,  411. 

Suppuration,  124. 
Suppurative  Gingivitis,  159. 
Sylvester's   Method   of    Resuscitation, 

262. 
Symptoms  of  Inflammation,   1 14,  1 19. 
Syncope,  Fainting,  187. 
Synopsis  of  Treatment  of  Affections  of 

the  Mouth,  148. 
Synthetic  Carbolic  Acid,  218. 
Syphilitic  Inflammations  of  the  Mouth, 
161. 
Teeth,  177. 
Ulcers,  161. 
Syrup   of    Lacto- Phosphate   of   Lime, 

513- 
Syrups,  III. 
Syrupus  Calcii  Lacto-Phosphatis,  314, 

513- 
Hypophosphitum,  514. 

TABLE  of  Doses  of  Medicines,  43. 
of  Elementary  Substances,  73. 
of  Equivalents,  29. 
of  Solubility    of  Chemicals  in 
Water  and  Alcohol,  74. 
Tables  of  Percentage  Solutions,  20. 
Tablets,  in. 
Tannic  Acid,  240. 
Tartaric  Acid,  244. 
Tartrate  of  Chinoline,  326. 
Teeth,  Eruption  of,  596. 
Temperaments,  20. 
Temperature,  72. 
Terchloride  of  Gold,  303. 

of  Phenol,  558. 
Terebinthina,  559. 
Terebinthene,  Terpine,  Terpinol,  Ter- 

bene,  560. 
Teriodide  of  Formyl,  429. 
Terminations  of  Inflammation,  130. 
Test  Papers  for  Dentists,  591. 
Tests  for  Arsenic.  206. 
Test  for  Bichloride  of  Mercury,  423. 
Test  for  Presence  of  Cocaine,  361. 
Test  for  Peroxide  of  Hydrogen,  504. 


GENERAL   INDEX. 


623 


Tetra-iodo-ethylene-diodotorm,  434. 
Tetraiodopyrrol,  434. 
Therapeutics,  17. 
Thermometers,  71,  72. 
Thiersch's    Method    of   Morphia  Nar- 
cosis, 344. 

Solution,  235. 
Thrush,  166. 
Thymacetin,  564. 
Thymol,  561. 
Tinctura  Aconiti,  246. 

Arnica,  299. 

Calendula,  312. 

Capsici,  321. 

Tinctura  Catechu,  325. 

Eucalypti,  399. 

Gelsemii,  413. 

lodi,  438. 

lodi  Composita,  438. 

Kino,  449. 

Kramerige,  447. 

Myrrhse,  468. 

Opii,  492. 

Opii  Camphorata,  493. 

Opii  Deodorata,  493. 

Pyrethri,  530. 

Tinctura  Strophanthi,  556. 

Veratri  Viridis,  573. 
Tinctures,  iii. 

To  Render  Hands  Aseptic,  590. 
Tongue,   Characteristic   Indication   of, 

187. 
Tonics,  80. 

Topical  Remedies,  18,  32,  78. 
Treatment  of  Cocaine  Poisoning,  360. 
Treatment  of  Dangerous  Symptoms  of 
Anaesthesia,  261. 

of  Inflammation,  13 1. 
Trichloride  of  Iodine,  442. 
Tri-Brom-Phenol,  308. 
Trichloracetic  Acid,  564. 
Tri-Methyl  Ethylene,  497. 
Troches  of  Chlorate  of  Potassium,  524. 
Tropacocaine,  566. 

Tropacocaine     Benzoyl-pseudo-tropein, 
566. 


Troy  Weight,  26. 

Tumor  of  Jaws,  Malignant   Form   of, 
162. 
of  Upper  Jaws,  162. 
Turpentine,  559. 

Turpentine    as   a   Sterilizer  of  Instru- 
ments, etc.,  561. 

ULCERATION,  13S. 
Ulceration,  Alveolar,  156. 
Ulcers,  138. 

Ulcers  of  Mouth,  Syphilitic,  161. 
Ulcerous  Stomatitis,  160. 
Ulitis,  159. 

Unerupted  Impacted  Tooth,  163. 
Unguentum  Acidi  Carbolici,  215. 

Acidi  Tannici,  243. 

Boricum,  211. 

Creasoti,  373. 

Gallse,  225. 

Hydrargyri,  426. 

Veratrina,  572. 
Urethran,  569. 
Urethrane,  569. 

VAN  WOERT'S  Method  of  Bleach- 
ing Discolored  Teeth,  508. 
Vapocaine,  361. 
Variation    in    the    Frequency    of   the 

Pulse,  69. 
Varieties  of  Pus,  126. 
Varnish,  Colored,  545. 

Aqueous,  545. 

Transparent,  544. 

Dental,  436. 
Vaselin,  569. 

Vaseline  Camphor  Ice,  57 1. 
Vaselone,  571. 
Veratrina,  571. 
Veratrine,  571. 
Veratrum  Viride,  572. 
Vermifuges,  97. 
Vermilion,  427. 

Vermilion,  Effects  of,  on  Mouth,  427. 
Vesicants,  107. 
Vienna  Paste,  519. 


624 


GENERAL  INDEX. 


Vinum,  274. 
Vinum  Opii,  492. 
Pepsini,  499. 
Vitalized  Air,  478. 
Volasem,  360. 
Voltaic  Narcotism,  267. 
Von  Bonhorst's  Method,  268. 

W  ALB'S    Method    of    Using  Co- 
caine, 356. 
Obolinskie's  Method,  358. 
Raymond's  Method,  357. 
Weights  and  Measures,  26. 
White  Oak  Bark,  535. 
White  Oxide  of  Arsenic,  195. 
Windle's    Method    of    Administering 

Anaesthetics,  259. 
Wine  of  Opium,  492. 

of  Pepsin,  499. 
Wintergreen,  411. 


Witch  Hazel,  418. 

Wolfsbane,  245. 

Wood  Charcoal,  323. 

Wyeth's  Antiseptic  Solution,  401. 

I 
WANTHOXYLUM,  574. 

YELLOW  Cinchona,  346. 
Jasmine,  412. 
Yversen's    Method  of   Administering 
Anaesthetics,  260. 

ZINCI  Chloridum,  575. 
Filling    Materials,   231,    232, 
579.  580. 
lodidum,  577. 
Oxidum,  578. 
Sulphas,  580. 
Sulpho-Carbolate,  216,  577. 


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SECOND  EDITION,  JUST  READY 

TYSON'S  Practice  of  Medicine 

A  TEXT-BOOK  FOR  PRACTITIONERS  AND  STUDENTS 
WITH  SPECIAL  REFERENCE  TO  DIAGNOSIS  AND  TREATMENT 


By  JAMES  TYSON,  M.D. 

Professor  of  Medicine  in  the  University  of  Pennsylvania ;   Physician  to  the  University  and 
Philadelphia  Hospitals,  etc. 


COLORED  PLATES  AND  J25  OTHER  ILLUSTRATIONS 
Octavo*     J222  Pages.    Cloth,  $5.50 ;  Leather,  $6.50 ;  Half  Russia,  $7.50 


The  object  of  this  book  is — first,  to  aid  the  student  and  physician  to  recognize 
disease,  and,  second,  to  point  out  the  proper  methods  of  treatment.  To  this  end 
Diagnosis  and  Treatment  receive  special  attention,  while  pathology  and 
morbid  anatomy  have  such  consideration  as  is  demanded  by  their  importance  as  funda- 
mental conditions  of  a  thorough  understanding  of  disease.  Dr.  Tyson's  qualifications 
for  writing  such  a  work  are  unequaled.  It  is  really  the  outcome  of  over  thirty 
years*  experience  in  teaching  and  in  private  and  hospital  practice.  As  a 
teacher  he  has,  while  devoting  himself  chiefly  to  clinical  medicine,  occupied  several 
important  chairs,  notably  those  of  General  Pathology  and  Morbid  Anatomy,  and 
Clinical  Medicine  in  the  University  of  Pennsylvania,  an  experience  that  has  necessarily 
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Edition  has  been  most  thoroughly  revised,  parts  have  been  rewritten,  new 
material  and  illustrations  have  been  added,  and  in  many  respects  it  may  be  considered 
a  new  book. 

"  It  is  in  the  writing  and  preparation  of  a  work  of  this  character  that  Dr.  Tyson  stands  pre- 
eminent. Those  of  the  profession — and  there  are  many  at  this  time — who  have  been  fortunate  to 
have  been  his  pupils  during  their  medical  student  days,  will  remember  that  he  brought  to  his 
lectures  and  to  his  writings  an  amount  of  industry  and  care  which  many  other  teachers  failed  to 
bring ;  and  those  who  know  him  best  as  an  author  and  teacher  have  expected  that  his  book  on  the 
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reputation  as  a  medical  author.    This  belief  has  proved  correct. ' ' —  Therapeutic  Gazette,  Detroit,  Mich. 

"  After  a  third  of  a  century  spent  in  the  assiduous  study,  practice,  and  teaching  of  medicine, 
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text-book  is  not  only  a  proper  ambition,  but  is  really  expected  by  students  and  the  profession.  So 
Professor  Tyson  best  shows  his  modesty  by  making  no  apology  for  the  present  work." — American 
Journal  of  Medical  Sciences,  Philadelphia. 

4 


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Carpenter.     The  Microscope  and  Its  Revelations. 
By  W.  B.   Carpenter,   m.d.,   f.r.s.     Eighth  Edition,  by  Rev.   Dr.  Dallinger, 
F.R.s.     Revised    and    Enlarged,    with    800    Illustrations    and    many    Lithographs. 
Octavo.  Nearly  Ready. 

Cazeaux  and  Tarnier's  Midwifery.     With  Appendix,  by  Munde. 

The  Theory  and  Practice  of  Obstetrics,  including  the  Diseases  of  Pregnancy  and 
Parturition,  Obstetrical  Operations,  etc.  By  P.  Cazeaux;  Remodeled,  rearranged, 
and  revised  by  S.  Tarmer,  m.d.  Eighth  American  from  the  Eighth  French  and 
First  Italian  Edition.  Edited  by  Robert  J.  Hess,  m.d..  Physician  to  the  Northern 
Dispensary,  Philadelphia,  etc.  With  an  Appendix  by  Paul  F.  Munde,  m.d.,  Pro- 
fessor of  Gynecology  at  the  New  York  Polyclinic.  Illustrated  by  Lithographs,  Full- 
page  Plates,  and  numerous  Engravings.     8vo.         Cloth,  $4.50;  Full  Leather,  $5.50 

Clowes  and  Coleman.     Quantitative  Analysis. 

Adapted  for  the  Use  of  the  Laboratories  of  Schools  and  Colleges.  By  Frank  Clowes, 
Sc.D.,  Emeritus  Professor  of  Chemistry,  University  College,  Nottingham,  and  I. 
Bernard  Coleman,  Assoc.  R.  C.  Sci. ,  Dublin,  Professor  of  Chemistry,  Southwest 
London  Polytechnic.     Fifth  Edition.      122  Illustrations.     Just  Ready.     Cloth,  $3.50 

Coblentz.      Manual  of  Pharmacy. 

A  Text-Book  for  Students.  By  Virgil  Coblentz,  a.m.,  ph.d.,  f.c.s..  Professor  of 
Chemistrj'  and  Physics  ;  Director  of  Pharmaceutical  Laboratory,  College  of  Phar- 
macy of  the  City  of  New  York.  Second  Edition,  Revised  and  Enlarged.  437  Illus- 
trations.    Octavo.     572  pages.         Cloth,  $3.50;  Sheep,  $4.50;  Half  Russia,  $5.50 

The  Newer  Remedies. 

Including  their  Synonyms,  Sources,  Methods  of  Preparation,  Tests,  Solubilities, 
and  Doses  as  far  as  known.  Together  with  Sections  on  Organo-Therapeutic 
Agents  and  Indifferent  Compounds  of  Iron.  Third  Edition,  very  much  enlarged. 
Octavo.  Cloth,  $1.00 

Volumetric  Analysis. 

A  Practical  Handbook  for  Students  of  Chemistry.     Illustrated.     Svo.     In  Press. 

Cohen.     System  of  Physiologic  Therapeutics.     Illustrated. 

A  Practical  Exposition  of  the  Methods  Other  than  Drug-giving,  Useful  in  the  Treat- 
ment of  the  Sick.  Edited  by  Solomon  Solis  Cohen,  a.m.,  m.d..  Professor  of 
Medicine  and  Therapeutics  in  the  Philadelphia  Polyclinic  ;  Lecturer  on  Clinical 
Medicine  at  Jefferson  Medical  College  ;  Physician  to  the  Philadelphia  and  Rush  Hos- 
pitals ;  formerly  Lecturer  on  Therapeutics,  Dartmouth  Medical  College.  To  be 
issued  in  Eleven  Compact  Octavo  Volumes.        Price  for  Set  Complete,  Cloth,  $22.00 

Electrotherapy.     Illustrated.     Two  Volumes. 

By  George  W.  Jacoby,  m.d..  New  York,  Consulting  Neurologist  to  the  German 
Hospital,  to  the  Infirmary  for  Women  and  Children,  to  the  Craig  Colony  for 
Epileptics,  etc.  Special  articles  by  Edward  Jackson,  a.m.,  m.d.,  Denver, 
Col. ;  Emeritus  Professor  of  Diseases  of  the  Eye  in  the  Philadelphia  Polyclinic  ; 
Member  American  Ophthalmological  Society  ;  Fellow  and  ex-President  American 
Academy  of  Medicine,  etc. — By  William  Scheppegrell,  m.d..  New  Orleans, 
Member  American  Laryngological,  Rhinological,  and  Otological  Society. — 
By  J.  Chalmers  Da  Costa,  m.d.,  Clinical  Professor  of  Surgery  in  Jefferson 
Medical  College  ;  Surgeon  to  the  Philadelphia  and  to  St.  Joseph's  Hospitals, 
etc. — By  Franklin  H.  Martin,  m.d..  Professor  of  Gynecology,  Post-Graduate 
Medical  School  of  Chicago  ;  Gynecologist  Chicago  Charity  Hospital ;  Chairman 
Section  of  Obstetrics  and  Diseases  of  Women  of  the  American  Medical  Asso- 
ciation (1895),  etc.  By  A.  H.  Ohmanx-Dumesnil,  m.d.,  Editor  .S7.  Louis 
Medical  and  Surgical  Journal ;  Member  International  Dermatological  Congress  ; 
formerly  Professor  of  Dermatology,  St.  Louis  Medical  College,  etc. 


10  p.  BLAKISTON'S  SON  6-   CO.'S 


Cohen.     Physiologic  Therapeutics. — Continued. 

Climatology   and   Health   Resorts,    Including   Mineral    Springs. 

Two  Volumes,  with  Maps. 

By  F.  Parkes  Weber,  m.a.,  m.d.,  f.r.c.p.  (Lond.),  Physician  to  the  German 
Hospital,  Dalston  ;  Assistant  Physician  North  London  Hospital  for  Consump- 
tion ;  Author  of  "The  Mineral  Waters  and  Health  Resorts  of  Europe  ;"  and 
Guy  Hinsdale,  a.m.,  m.d..  Secretary  of  the  American  Chmatological  Associa- 
tion ;  President  of  the  Pennsylvania  Society  for  the  Prevention  of  Tuberculosis  ; 
formerly  Lecturer  on  Medical  Climatology  in  the  University  of  Pennsylvania,  etc. 

Prophylaxis — Personal  Hygiene — Care  of  the  Sick.     Illustrated. 

By  Harold  C.  Ernst,  m.d.,  Professor  of  Bacteriology  in  the  Medical  School  of 
Harvard  University,  Boston  ;  and  Albert  Abrams,  m.d.  (University  of  Heidel- 
berg), formerly  Professor  of  Pathology,  Cooper  Medical  College,  San  Francisco. 

Dietotherapy.     Food  in  Health  and  Disease. 

By  Nathan  S.  Davis,  Jr.,  a.m.,  m.d..  Professor  of  Principles  and  Practice  of 
Medicine  in  Northwestern  University  Medical  School  ;  Physician  to  Mercy  Hos- 
pital, Chicago  ;  Member  American  Academy  of  Medicine,  American  Chmato- 
logical Society,  etc. 

Mechanotherapy.     Illustrated. 

By  John  Kearsley  Mitchell,  m.d..  Assistant  Physician  to  the  Orthopedic 
Hospital  and  Infirmary  for  Nervous  Diseases  ;  Assistant  Neurologist  Presbyterian 
Hospital,  Philadelphia  ;  Attending  Physician  to  the  Pennsylvania  School  for 
Feeble-minded  Children  ;  Fellow  College  of  Physicians  of  Philadelphia,  etc. , 
formerly  Lecturer  on  Symptomology  at  the  University  of  Pennsylvania  ;  and 
Luther  Gulick,  m.d.,  of  Brooklyn,  N.  Y.,  formerly  of  Springfield,  Mass.,  Mem. 
American  Association  for  Advancement  of  Physical  Education,  Amer.  Medical 
Association,  etc. 

Rest — Mental  Therapeutics — Suggestion. 

By  Francis  X.  Dercum,  m.d..  Clinical  Professor  of  Nervous  Diseases  in  Jeffer- 
son Medical  College  ;  Neurologist  to  the  Philadelphia  Hospital ;  Consulting 
Physician  to  the  State  Asylum  for  the  Chronic  Insane  at  Wernersville,  Penna. ; 
Consulting  Neurologist  to  St.  Agnes'  Hospital  ;  Neurologist  to  the  Jewish  Hos- 
pital of  Philadelphia. 

Hydrotherapy — Thermotherapy — Balneology — Phototherapy. 

By  Dr.  Wilhelm  Winternitz,  Professor  of  Clinical  Medicine  in  the  University 
of  Vienna  ;  Director  of  the  General  Polyclinic  in  Vienna,  etc. ;  and  Dr.  E. 
Heinrich  Kisch,  Professor  in  the  University  of  Prague  ;  Physician  at  Marien- 
bad  Spa. 

Pneumatotherapy  and  Inhalation  Methods.     Illustrated. 

By  Dr.  Paul  Tissier,  Chief  of  Clinic  of  the  Faculty  of  Medicine  of  Paris. 

Serotherapy — Organotherapy — Blood-Letting,  etc. — Principles  of 
Therapeutics — Digest — I  ndex. 

By  Joseph  McFarland,  m.d..  Professor  of  Pathology  in  the  Medico-Chirurgical 
College,  Philadelphia  ;  Pathologist  to  the  Medico-Chirurgical  Hospital  and  to  the 
Rush  Hospital  for  Consumptives  and  Allied  Diseases,  etc. — O.  T.  Osborne, 
m.d..  Professor  of  Materia  Medica  and  Therapeutics,  Medical  Department,  Yale 
University,  New  Haven. — Frederick  A.  Packard,  m.d..  Visiting  Physician  to 
the  Pennsylvania  and  to  the  Children's  Hospitals. — The  Editor,  and  Augustus 
A.  EsHNER,  M.D.,  Professor  of  Clinical  Medicine  in  the  Philadelphia  Polyclinic  ; 
Physician  to  the  Philadelphia  Hospital,  etc. 
*„*  Complete  descriptive  circular  upon  application. 


MEDICAL  AND   SCIENTIFIC  PUBLICATIONS.  11 

Cohen.     The  Throat  and  Voice. 

By  J.  SoLis  Cohen,  m.d.     Illustrated.      i2mo.  Cloth,  .40 

Congdon.     Laboratory  Instructions  in  General  Chemistry. 

By  Ernest  A.  Congdon,  Professor  of  Chemistry  in  the  Drexel  Institute,  Philadelphia  ; 
Member  American  Chemical  Society  ;  Fellow  of  the  London  Chemical  Society,  etc. 
With  an  Appendix,  useful  Tables,  and  56  Illustrations.  Interleaved,  Cloth,  $1.00 

Conn.     Agricultural  Bacteriology. 

Including  a  Study  of  Bacteria  as  Relating  to  Agriculture,  with  Special  Reference  to 
the  Bacteria  in  Soil,  in  the  Dairy,  in  Food  Products,  in  Domestic  Animals,  and  in 
Sewage.  By  H.  W.  Conn,  Ph.D.,  Professor  of  Biology,  Wesleyan  University, 
Middletown,  Conn.;  Author  of  "Evolution  of  To-day,"  "  The  Story  of  Germ  Life," 
etc.     With  Illustrations.  In  Press. 

Cooper.     Syphilis.     Colored  Plate. 

By  Alfred  Cooper,  f.r.c.s..  Senior  Surgeon  to  St.  Mark's  Hospital ;  late  Surgeon 
to  the  London  Lock  Hospital,  etc.  Second  Edition,  Edited  by  Edward  Cot- 
terell,  f.r.c.s.,  Surgeon  London  Lock  Hospital,  etc.  20  Full-page  Plates  contain- 
ing many  Colored  Figures.     Octavo.  Cloth,  $5.00 

Coplin.     Manual  of  Pathology.     Third  Edition.     330  Illustrations. 

Including  Bacteriology,  the  Technic  of  Post-mortems,  and  Methods  of  Pathologic 
Research.  By  W.  M.  Late  Coplin,  m.d..  Professor  of  Pathology  and  Bacteriology, 
Jefferson  Medical  College  ;  Pathologist  to  Jefferson  Medical  College  Hospital  and  to 
the  Philadelphia  Hospital ;  Bacteriologist  to  the  Pennsylvania  State  Board  of  Health. 
Third  Edition,  Rewritten  and  Enlarged.  330  Illustrations,  many  of  which  are  origi- 
nal, and  7  Colored  Plates.     8vo.     Jtist  Ready.  Cloth,  $3. 50 

Practical  Hygiene. 

With  Special  Articles  on  Plumbing,  Ventilation,   etc.      138  Illustrations.     Bvo. 
Second  Edition.  In  Preparation. 

Cripps.     Ovariotomy  and  Abdominal  Surgery. 

By  Harrison  Cripps,  f.r.c.s..  Surgical  Staff,  St.  Bartholomew's  Hospital,  London. 
With  17  Plates  and  115  other  Illustrations.     Large  Octavo.  Cloth,  $8.00 

Crocker.     Diseases  of  the  Skin. 

Their  Description,  Pathology,  Diagnosis,  and  Treatment,  with  Special  Reference  to 
the  Skin  Eruptions  of  Children.  By  H.  Radcliffe  Crocker,  m.d..  Physician  to 
the  Department  of  Skin  Diseases,  University  College  Hospital,  London.  92  Illustra- 
tions.    Third  Edition.  Preparing. 

Cuff.     Lectures  on  Medicine  to  Nurses. 

By  Herbert  Edmund  Cuff,  m.d.,  late  Assistant  Medical  Officer,  Stockwell  Fever 
Hospital,  England.     Second  Edition,  Revised.     With  25  Illustrations.     Cloth,  $1.25 

Cushing.     Compend  of  Histology. 

Specially  adapted  for  the  use  of  Medical  Students  and  Physicians.  By  H.  H.  Cushing, 
M.D.,  Director  of  Histological  and  Embryological  Laboratories,  Woman's  Medical 
College  of  Pennsylvania  ;  Demonstrator  of  Histology  and  Embryology,  Jefferson 
Medical  College,  Philadelphia.  Illustrated.  No.  //  ?  Quiz-Cotnpend?  Series. 
l2mo.  Cloth,  .80;  Interleaved  for  Notes,  $1.00 

Dalby.     Diseases  and  Injuries  of  the  Ear. 
By  Sir  William  B.  Dalby,  m.d..  Aural  Surgeon  to  St.  George's  Hospital,  London. 
Fourth  Edition.     With  38  Wood  Engravings  and  8  Colored  Plates.  Cloth,  $2.50 


> 


12  P.  BLAKISTON'S  SON  &>   CO.'S 


Davis.     Dietotherapy.     Food  in  Health  and  Disease. 
See  Cohen,  Physiologic  Therapeutics,  page  lo. 

Davis.     Essentials  of  Materia  Medica  and  Prescription  Writing. 

By  J.  Aubrey  Davis,  m.d.,  late  Assistant  Demonstrator  of  Obstetrics  and  Quiz- 
Master  in  Materia  Medica,  University  of  Pennsylvania.      i2mo.  Cloth,  $1.50 

Domville.     Manual  for  Nurses 

and  Others  Engaged  in  Attending  to  the  Sick.  By  Ed.  J.  Domville,  m.d.  Eighth 
Edition,  Revised.     With  Recipes  for  Sick-room  Cookery,  etc.      i2mo.         Cloth,  .75 

Donders.     Refraction.     Portrait  of  Author. 

An  Essay  on  the  Nature  and  the  Consequences  of  Anomalies  of  Refraction.  By  F. 
C.  Donders,  m.d.,  late  Professor  of  Physiology  and  Ophthalmology  in  the  Univer- 
sity of  Utrecht.  Authorized  Translation.  Revised  and  Edited  by  Charles  A. 
Oliver,  a.m.,  m.d.  (Univ.  Pa.),  one  of  the  Attending  Surgeons  to  the  Wills  Eye 
Hospital ;  one  of  the  Ophthalmic  Surgeons  to  the  Philadelphia  Hospital,  etc.  With 
a  Portrait  of  the  Author  and  a  Series  of  Explanatory  Diagrams.     Octavo. 

Half  Morocco,  Gilt,  $1.25 

Da  Costa.     Clinical  Pathology  of  the  Blood.     Colored  Plates. 

A  Practical  Guide  to  the  Examination  of  the  Blood  by  Clinical  Methods,  with  Refer- 
ence to  the  Diagnosis  of  Disease.  By  John  C.  Da  Costa,  Jr.,  m.d..  Assistant 
Demonstrator  of  Clinical  Medicine  in  the  Jefferson  Medical  College,  Philadelphia  ; 
Assistant  in  the  Medical  Clinic,  Jefferson  Medical  College  Hospital ;  Hasmatologist 
to  the  German  Hospital.     With  six  Colored  Plates  and  other  Illustrations.     Octavo. 

In  Press. 

Deaver.     Surgical  Anatomy.     400  Full-page  Plates. 

A  Treatise  on  Human  Anatomy  in  its  Application  to  the  Practice  of  Medicine  and 
Surgery.  By  John  B.  Deaver,  m.d.,  Surgeon-in-Chief  to  the  German  Hospital; 
Surgeon  to  the  Children's  Hospital  and  to  the  Philadelphia  Hospital ;  Consulting 
Surgeon  to  St.  Agnes',  St.  Timothy's,  and  Germantown  Hospitals  ;  formerly  Assistant 
Professor  of  Applied  Anatomy,  University  of  Pennsylvania,  etc.  With  over  400 
very  handsome  Full-page  Illustrations  engraved  from  original  drawings  made  by 
special  artists  from  dissections  prepared  for  the  purpose  in  the  dissecting-rooms  of  the 
University  of  Pennsylvania.  Three  large  volumes.  Royal  square  octavo.  Sold  by 
Subscription.  Orders  taken  for  complete  sets  only.  Description  upon  Application. 
Cloth,  $21. cx);  Half  Morocco  or  Sheep,  $24.00;  Half  Russia,  $27.00 

Synopsis  of  Contents. 
Volume  I. — Upper  Extremity — Back  of  Neck,  Shoulder,  and  Trunk — Cranium 

— Scalp — Face. 
Volume  II. — Neck — Mouth,   Pharynx,    Larynx,   Nose — Orbit — Eyeball — Organ 

of  Hearing — Brain — Female  Perineum — Male  Perineum. 
Volume  III. — Abdominal  Wall — Abdominal   Cavity — Pelvic    Cavity — Chest — 

Lower  Extremity. 

"  In  summing  up  the  general  excellences  of  this  remarkable  work,  we  can  accord  our  unqual- 
ified praise  for  the  accurate,  exhaustive,  and  systematic  manner  in  which  the  author  has  carried  out 
<l    his  plan,  and  we  can  commend  it  as  a  model  of  its  kind,  which  must  be  possessed  to  be  appre- 
ciated."—  The  Medical  Record,  New  York. 

.  Appendicitis.     Second  Edition. 

Its  History,  Anatomy,  Etiology,  Pathology,  Symptoms,  Diagnosis,  Prognosis, 
Treatment,  Complications,  and  Sequelae.  A  Systematic  Treatise,  with  22  Plates, 
10  of  which  are  Colored,  drawn  specially  for  this  work.  Second  Edition,  Re- 
vised and  Rewritten.      8vo.     Just  Ready.  Cloth,  $3.50 


MEDICAL   AND   SCIENTIFIC  PUBLICATIONS.  13 

Dercum.     Rest — Mental  Therapeutics — Suggestion. 
See  Cohen,  Physiologic  Therapeutics,  page  lo. 

Duckworth.     On  Gout.     Illustrated. 

A  Treatise  on  Gout.  By  Sir  Dyce  Duckworth,  m.d.  (Edin.),  f.r.c.p.,  Physician  to, 
and  Lecturer  on  Chnical  Medicine  at,  St.  Bartholomew's  Hospital,  London.  With 
Chromo-lithographs  and  Engravings.     Octavo.  Cloth,  $6.00 

Diihrssen.     A  Manual  of  Gynecological  Practice. 

By  Dr.  A.  Duhrssen,  Privat-Docent  in  Midwifery  and  Gynecology  in  the  University 
of  Berlin.  Translated  from  the  Fourth  German  Edition  and  Edited  by  John  W. 
Taylor,  f.r.c.s.,  Surgeon  to  the  Birmingham  and  Midlands  Hospital  for  Women  ; 
Vice-President  of  the  British  Gynecological  Society  ;  and  Frederick  Edge,  m.  d.  , 
M.R.C.P.,  F.R.C.S.,  Surgeon  to  the  Wolverhampton  and  District  Hospital  for  Women. 
With  105  Illustrations.      i2mo.  Cloth,  $1.50 

Dulles.     What  to  Do  First  In  Accidents  and  Poisoning. 

By  C.  W.  Dulles,  m.d..  Surgeon  to  the  Rush  Hospital ;  formerly  Assistant  Surgeon 
2d  Regiment  N.  G.  Pa.,  etc.  Fifth  Edition,  Enlarged.  With  new  Illustrations. 
i2mo.  Cloth,  $1.00 

Edgar.     Text-Book  of  Obstetrics. 

By  J.  Clifton  Edgar,  m.d..  Professor  of  Obstetrics  Medical  Department  of  Cornell 
University,  New  York  City  ;  Physician  to  Mothers'  and  Babies'  Hospital,  and  to  the 
Emergency  Hospital,  etc.  With  many  Illustrations,  a  large  number  of  which  are 
Original.     Octavo.  In  Preparation. 

Ernst.     Prophylaxis — Personal   Hygiene — Nursing  and  Care  of  the 
Sick. 
See  Cohen,  Physiologic  Therapeutics,  page  10. 

Fenwick.     Guide  to  Medical  Diagnosis. 

By  Samuel  Fenwick,  m.d.,  f.r.c.p.,  Consulting  Physician  to  the  London  Hospital ; 
and  W.  S.  Fenwick,  m.d.,  m.r.c.p..  Physician  to  the  Out-Patients,  Evelina  Hospital 
for  Children.  Eighth  Edition,  in  great  part  Rewritten,  with  several  New  Chapters. 
135  Illustrations.  Cloth,  $2.50 

Ulcer  of  the  Stomach  and  Duodenum. 

42  Illustrations.     Royal  octavo.     Just  Ready.  Cloth,  $3.50 

Fick.     Diseases  of  the  Eye  and  Ophthalmoscopy. 

A  Handbook  for  Physicians  and  Students.  By  Dr.  Eugen  Fick,  University  of 
Zurich.  Authorized  Translation  by  A.  B.  Hale,  m.d..  Ophthalmic  Surgeon  United 
Hebrew  Charities  ;  Consulting  Ophthalmic  Surgeon  Charity  Hospital,  Chicago  ;  late 
Vol.  Assistant  Imperial  Eye  Clinic,  University  of  Kiel.  With  a  Glossary  and  158 
Illustrations,  many  of  which  are  in  Colors.     8vo. 

Cloth,  $4.50;  Sheep,  $5.50;  Half  Russia,  $6.50 

Fillebrown.     A  Text-Book  of  Operative  Dentistry. 

Written  by  invitation  of  the  National  Association  of  Dental  Faculties.  By  Thomas 
Fillebrown,  m.d.,  d.m.d..  Professor  of  Operative  Dentistry  in  the  Dental  School  of 
Harvard  University  ;  Member  of  the  American  Dental  Association,  etc.  Illustrated. 
Svo.  Cloth,  $2.25 


14  P.  BLAKISTON'S  SON  <^    CO:  S 

Fowler's  Dictionary  of  Practical  Medicine. 

By  Various  Writers.  An  Encyclopedia  of  Medicine.  Edited  by  James  Kingston 
Fowler,  m.a.,  m.d.,  f.r.c.p.,  Senior  Assistant  Physician  to,  and  Lecturer  on  Patho- 
logical Anatomy  at,  the  Middlesex  Hospital,  London.     8vo. 

Cloth,  $3.00  ;  Half  Morocco,  $4.00 

Fullerton.     Obstetric  Nursing. 

By  Anna  M.  Fullerton,  m.d..  Demonstrator  of  Obstetrics  in  the  Woman's  Medical 
College  ;  Obstetrician  and  Gynecologist  to  the  Woman's  Hospital,  Philadelphia,  etc. 
41  Illustrations.     Fifth  Edition,  Revised  and  Enlarged.      i2mo.  Cloth,  $1.00 

Surgical  Nursing. 

Comprising  the  Regular  Course  of  Lectures  upon  Abdominal  Surgery,  Gyne- 
cology, and  Genera;l  Surgical  Conditions  delivered  at  the  Training  School  of 
the  Woman's  Hospital,  Philadelphia.  Third  Edition,  Revised.  69  Illustrations. 
i2mo.  Cloth,  $1.00 

Gardner.     The  Brewer,  Distiller,  and  Wine  Manufacturer. 

A  Handbook  for  all  interested  in  the  Manufacture  and  Trade  of  Alcohol  and  its 
Compounds.     Edited  by  John  Gardner,  F.c.s.     Illustrated.  Cloth,  $1.50 

Goodall  and  Washbourn.     A  Manual  of  Infectious  Diseases. 

By  Edward  W.  Goodall,  m.d.  (London),  Medical  Superintendent  Elastern  (Fever) 
Hospital,  Homerton,  London,  etc.  ;  and  J.  W.  Washbourn,  f.r.c.p..  Assistant 
Physician  to  Guy's  Hospital  and  Physician  to  the  London  Fever  Hospital.  Illustra- 
ted with  Charts,  Diagrams,  and  Full-page  Plates.  Cloth,  $3.00 

Gould.      The    Illustrated    Dictionary    of    Medicine,    Biology,    and 
Allied  Sciences.     Fifth  Edition. 

Being  an  Exhaustive  Lexicon  of  Medicine  and  those  Sciences  Collateral  to  it : 
Biology  (Zoology  and  Botany),  Chemistry,  Dentistry,  Pharmacology,  Microscopy, 
etc.  By  George  M.  Gould,  a.m.,  m.d..  Editor  of  American  Medicine ;  President, 
1893-94,  American  Academy  of  Medicine,  etc.  With  many  Useful  Tables  and  numer- 
ous Fine  Illustrations.  Large  Square  Octavo.  1633  pages.  Fifth  Edition.  Just 
Ready.  Full  Sheep  or  Half  Dark-Green  Leather,  $10.00 

With  Thumb  Index,  $11.00;  Half  Russia,  Thumb  Index,  $12.00 

"  Few  persons  read  dictionaries  as  Theophile  Gautier  did — for  pleasure ;  if,  however,  all 
dictionaries  were  as  readable  as  the  one  under  consideration,  his  taste  for  this  kind  of  literature 
would  be  less  singular.  .  .  .  The  book  is  excellently  printed,  and  the  illustrations  are  admir- 
ably executed.  The  binding  is  substantial  and  even  handsome,  but  the  business-like  '  get-up  '  of 
the  book  makes  it  well  fitted  for  use  as  well  as  for  the  adornment  of  a  book-shelf." — The  British 
Medical  Journal,  London. 

The  Student's  Medical  Dictionary.     Eleventh  Ed.     Illustrated. 

Enlarged.  Including  all  the  Words  and  Phrases  generally  used  in  Medicine, 
with  their  proper  Pronunciations  and  Definitions,  based  on  Recent  Medical 
Literature.  With  Tables  of  the  Bacilli,  Micrococci,  Leukomains,  Ptomains, 
etc.,  of  the  Arteries,  Muscles,  Nerves,  Ganglia,  and  Plexuses  ;  Mineral  Springs 
of  the  U.  S. ,  etc. ,  and  a  new  Table  of  Eponymic  Terms  and  Tests.  Rewritten, 
Enlarged,  and  Improved.    With  many  Illustrations.    Small  octavo.   840  pages. 

Half  Morocco,  $2.50;  Thumb  Index,  $3.00 

'*  One  pleasing  feature  of  the  book  is  that  the  reader  can  almost  invariably  find  the  definition 
under  the  word  he  looks  for,  without  being  referred  from  one  place  to  another,  as  is  too  commonly 
the  case  in  medical  dictionaries.  The  tables  of  the  bacilli,  micrococci,  leukomains,  and  ptomains 
are  excellent,  and  contain  a  large  amount  of  information  in  a  limited  space.  The  anatomical  tables 
are  also  concise  and  clear.  .  .  .  We  should  unhesitatingly  recommend  this  dictionary  to  our 
readers,  feeling  sure  that  it  will  prove  of  much  value  to  them." — The  American  Journal  of 
Medical  Science. 


MEDICAL   AND   SCIENTIFIC  PUBLICATIONS.  15 

Gould.    The  Pocket  Pronouncing  Medical  Lexicon.    Fourth  Edition. 
(30,000  Medical  Words  Pronounced  and  Defined.) 

A  Student's  Pronouncing  Medical  Lexicon.  Containing  all  the  Words,  their  Defini- 
tions and  Pronunciations,  that  the  Student  generally  comes  in  contact  with  ;  also 
elaborate  Tables  of  the  Arteries,  Muscles,  Nerves,  Bacilli,  etc.,  etc.;  a  Dose  List  in 
both  English  and  Metric  Systems,  a  new  table  of  Clinical  Eponymic  Terms,  etc., 
arranged  in  a  most  convenient  form  for  reference  and  memorizing.  Thin  64mo. 
(6x3^  inches.)  838  pages.  The  System  of  Pronunciation  used  in  this  book  is  very 
simple.     A  New  Edition. 

Full  Limp  Leather,  Gilt  Edges,  $1.00  ;  Thumb  Index,  $1.25 

"  This  '  Dictionary  '  is  admirably  suited  to  the  uses  of  the  lecture-room,  or  for  the  purposes  of 

a  medical  defining  vocabulary — many  of  the  words  not  yet  being  found  in  any  other  dictionary, 

large  or  small,  while  all  of  the  words  are  those  of  the  living  medical  literature  of  the  day." — The 

Virginia  Medical  Monthly. 

*^*  120,000  copies  of  Gould's  Dictionaries  have  been  sold. 
Sample  pages  and  descriptive  circulars  of  Gould' s  Dictionaries  free  upon  application. 

Borderland  Studies. 

Miscellaneous  Addresses  and  Essays  Pertaining  to  Medicine  and  the  Medical 
Profession,  and  their  Relations  to  General  Science.   35opages.   i2mo.  Cloth,  $2.00 

Gould  and   Pyle.     Cyclopedia   of  Practical    Medicine  and   Surgery. 
72  Special  Contributors.     Illustrated.     One  Volume. 

A  Concise   Reference   Handbook,    Alphabetically  Arranged,    of  Medicine,   Surgery, 
Obstetrics,  Materia  Medica,  Therapeutics,  and  the  various  specialties,  with  Particular 
Reference  to  Diagnosis  and  Treatment.     Compiled  under  the  Editorial  Supervision 
of  Drs.  George  M.  Gould  and  W.  L.  Pyle.     With  many  Illustrations. 
Large  Square  8vo.     To  correspond  with  Gould's  "  Illustrated  Dictionary." 

Full  Sheep  or  Half  Dark-Green  Leather,  $10.00  ;  With  Thumb  Index,  $11.00 

Half  Russia,  Thumb  Index,  |i2.oo 
*^*  The  great  success  of  Dr.  Gould's  "Illustrated  Dictionary  of  Medicine"  sug- 
gested the  preparation  of  this  companion  volume,  which  should  be  to  the  physician  the 
same  trustworthy  handbook  in  the  broad  field  of  general  information  that  the  Dictionary 
is  in  the  more  special  one  of  the  explanation  of  words  and  the  statement  of  facts.  The 
aim  has  been  to  provide  in  a  one-volume  book  all  the  material  usually  contained  in  the 
large  systems  and  much  which  they  do  not  contain.  Instead  of  long,  discursive  papers 
on  special  subjects  there  are  short,  concise,  pithy  articles  alphabetically  arranged,  giv- 
ing the  latest  methods  of  diagnosis,  treatment,  and  operating — a  working  book  in  which 
the  editors  and  their  collaborators  have  condensed  all  that  is  essential  from  a  vast 
amount  of  literature  and  personal  experience. 

The  seventy-two  special  contrilautors  have  been  selected  from  all  parts  of  the 
country  in  accordance  with  their  fitness  for  treating  special  subjects  about  which  they 
may  be  considered  expert  authorities.  They  are  all  men  of  prominence,  teachers, 
investigators,  and  writers  of  experience,  who  give  to  the  book  a  character  unequaled  by 
any  other  work  of  the  kind. 

At  each  reprinting  this  Cyclopedia  is  carefully  revised  and  augmented  so  as  to  in- 
clude important  innovations  and  in  order  to  keep  it  up-to-date. 

"The  book  is  a  companion  volume  to  Gould's  'Illustrated  Dictionary  of  Medicine,'  which 
every  physician  should  possess.  With  these  two  books  in  his  library,  every  busy  physician  will  save 
a  vast  amount  of  time  in  having  at  hand  an  instant  reference  cyclopedia  covering  every  subject  in 
surgery  and  medicine."  —Chicago  Medical  Recorder. 

Compend  of  Diseases  of  the  Eye  and  Refraction. 

Including  Treatment  and  Operations,  with  a  Section  on  Local  Therapeutics. 
With  Formulae,  Glossary,  and  several  Tables.  Second  Edition.  109  Illustra- 
tions, several  of  which  are  Colored.     No.  8  ? Quiz- Compend?  Series. 

Cloth,  .80  ;  Interleaved  for  Notes,  $1.00 


16  P.  BLAKISTON'S  SON  &-   CO.'S 

Gordinier.     The  Gross  and  Minute  Anatomy  of  the  Central  Nervous 

System.     261  Illustrations. 

By  H.  C.  Gordinier,  a.m.,  m.d..  Professor  of  Physiology  and  of  the  Anatomy  of 
the  Nervous  System  in  the  Albany  Medical  College  ;  Member  American  Neurological 
Association.  With  48  Full-page  Plates  and  213  other  Illustrations,  a  number  of 
which  are  printed  in  Colors  and  many  of  which  are  original.     Large  8vo. 

Handsome  Cloth,  $6.00  ;  Sheep,  $7.00  ;  Half  Russia,  $8.00 

*^*  It  is  universally  acknowledged  that  for  a  proper  comprehension  of  the  normal 
and  abnormal  activities  of  an  organ  a  thorough  knowledge  of  its  anatomy  is  absolutely 
essential.  This  is  particularly  true  of  diseases  of  the  central  nervous  system,  for  in  no 
other  way  can  the  disease-symptoms  be  explained.  Without  this  knowledge,  clinical 
and  pathological  observations  are  of  little  avail.  This  book  is  not  a  theoretic  and  tech- 
nical student' s  book,  but  a  useful  working  supplement  to  all  works  upon  general  practice 
and  neurology,  and  as  such  is  destined  to  mark  an  epoch  in  medical  literature. 

*^*  The  illustrations,  of  which  there  are  a  large  number,  are  chiefly  from  the 
author's  own  preparations.  They  have  been  reproduced  in  the  very  best  manner,  the 
publishers'  aim  being  to  give  results  that  are  scientifically  correct  and  at  the  same  time 
pleasing  to  the  eye.  In  order  that  certain  pictures  may  be  more  faithfully  shown,  they 
have  been  printed  in  colors  ;  this  will  bring  out  the  details  perfectly,  and  enable  the 
student  to  quickly  recognize  their  relative  value.  Those  illustrations  borrowed  from 
others  have  generally  been  remade,  so  that  they  will  harmonize  with  the  general  style 
adopted  for  the  work.  In  some  cases  these  have  been  improved  upon  in  details  which 
the  originals  failed  to  make  clear. 

"  This  is  an  excellent  book  on  a  fascinating  subject,  and  the  author  deserves  the  thanks  of  the 
English-speaking  medical  world  for  his  labor  in  getting  it  up.  There  are  works  enough  on  general 
anatomy,  and  dry  enough  they  are,  as  we  all  remember  only  too  well ;  but  the  anatomy  of  the 
nervous  system  alone  is  another  matter  entirely,  for  it  is  one  of  the  most  interesting  of  all  subjects 
of  medical  study  at  the  same  time  that  it  is  one  of  the  most  difficult.  For  both  of  these  reasons 
the  subject  is  deserving  of  a  treatise  by  itself,  and  should  not  be  briefly  discussed  in  a  few  pages  of 
a  general  work  on  anatomy  or  in  an  introductory  chapter  of  a  treatise  on  diseases  of  the  nervous 
system. ' ' —  T/ie  New  York  Medical  Record. 

Gorgas*  Dental  Medicine. 

A  Manual  of  Materia  Medica  and  Therapeutics.  By  Ferdinand  J.  S.  Gorgas,  m.  d.  , 
D.D.S.,  Professor  of  the  Principles  of  Dental  Science,  Oral  Surgery,  and  Dental 
Mechanism  in  the  Dental  Department  of  the  University  of  Maryland.  Sixth  Edition, 
Revised  and  Enlarged,  with  many  Formulae.     8vo. 

Cloth,  I4.00  ;  Sheep,  $5.00  ;  Half  Russia,  $6.00 

Greene.     The  Medical  Examination  for  Life  Insurance 

and  its  Associated  Clinical  Methods.  With  Chapters  on  the  Insurance  of  Sub- 
standard Risks  and  Accident  Insurance.  By  Charles  Lyman  Greene,  m.d.,  of  St. 
Paul,  Clinical  Professor  of  Medicine  and  Physical  Diagnosis  in  the  University  of  Min- 
nesota. With  99  Illustrations,  many  of  which  are  original,  several  being  printed 
in  Colors.     Octavo.     Just  Ready.  Cloth,  $4.00 

Griffith's  Graphic  Clinical  Chart. 

Designed  by  J.  P.  Crozer  Griffith,  m.d..  Instructor  in  Clinical  Medicine  in  the 
University  of  Pennsylvania.     Printed  in  three  colors.     Sample  copies  free. 

Put  up  in  loose  packages  of  50,   .50 
Price  to  Hospitals:   500  copies,  $4.00;   1000  copies,  $7.50.     With  name  of  Hos- 
pital printed  on,  50  cents  extra. 

Groff.     Materia  Medica  for  Nurses. 

With  Questions  for  Self-examination  and  a  very  complete  Pronouncing  Glossary. 
By  John  E.  Groff,  Pharmacist  to  the  Rhode  Island  Hospital,  Providence.  i2mo. 
235  pages.  Cloth,  $1.25 


MEDICAL  AND   SCIENTIFIC  PUBLICATIONS.  17 

Groves  and  Thorp.     Chemical  Technology. 

A  New  and  Complete  Work.     The  Application  of  Chemistry  to  the  Arts  and  Manu- 
factures.    Edited  by  Charles  E.  Groves,   f.r.s.,  and  Wm.  Thorp,  b.sc,  f.i.c, 
assisted  by  many  experts.    With  numerous  Illustrations.     Each  vo/utne  sold  separately. 
Vol.      I.     Fuel  and  Its  Applications.     607  Illustrations  and  4  Plates.     Octavo. 

Cloth,  $5.00;   }4,  Mor.,  $6.50 

Vol.     II.     Lighting.     Candles,  Oils,   Lamps,  etc.     By  W.  Y.  Dent,  L.  Field, 

Boverton   Redwood,  and  D.  A.  Louis.     Illustrated. 

Octavo.  Cloth,  $4.00;   }4.  Mor.,  I5.50 

Vol.   III.     Gas   Lighting.     By  Charles    Hunt,    Manager  of  the  Birmingham 

Gasworks.     Illustrated.     Octavo. 

Cloth,  ^53.50;  yi  Mor.,  $4.50 
Vol.  IV.  Electric  Lighting  and  Photometry.  By  Arthur  G.  Cooke,  m.a. 
(Cantab.),  Lecturer  on  Physics  and  Electric  Engineering 
at  the  Battersea  (London)  Polytechnic  ;  and  W.  J,  Dibdin, 
F.I.C,  F.C.S.,  late  Chemist  and  Superintending  Gas  Ex- 
aminer, London  County  Council.  In  Press. 

Gowers.     Manual  of  Diseases  of  the  Nervous  System. 

A  Complete  Text-Book.  By  William  R.  Gowers,  m.d.,  f.r.s..  Physician  to  Na- 
tional Hospital  for  the  Paralyzed  and  Epileptic  ;  Consulting  Physician,  University 
College  Hospital  ;  formerly  Professor  of  Clinical  Medicine,  University  College,  etc. 
Revised  and  Enlarged.     With  many  new  Illustrations.     Two  volumes.     Octavo. 

Vol.    I.     Diseases  of  the  Nerves  and  Spinal  Cord. 

Third  Edition.  Cloth,  $4.00  ;  Sheep,  $5.00  ;  Half  Russia,  $6.00 

Vol.  II.      Brain  and   Cranial   Nerves;    General   and   Functional 
Diseases. 

Second  Edition.  Cloth,  $4.00  ;  Sheep,  $5.00  ;  Half  Russia,  $6.00 

*^*  This  book  has  been  translated  into  German,  Italian,  and  Spanish.     It  is  pub- 
lished in  London,  Milan,  Bonn,  Barcelona,  and  Philadelphia. 

Syphilis  and  the  Nervous  System. 

Being  a  Revised  Reprint  of  the  Lettsomian  Lectures  for  1890,  delivered  before 
the  Medical  Society  of  London.      i2mo.  Cloth,  $1.00 

Medical  Ophthalmoscopy. 

A  Manual  and  Atlas,  with  Colored  Autotype  and  Lithographic  Plates  and  Wood- 
cuts, comprising  Original  Illustrations  of  the  changes  of  the  Eye  in  Diseases  of 
the  Brain,  Kidney,  etc.  Third  Edition,  Revised,  with  the  assistance  of  R. 
Marcus  Gunn,  f.r.c.S.,  Surgeon  Royal  London  Ophthalmic  Hospital,  Moor- 
fields.     Octavo.  Cloth,  $4.00 

Clinical  Lectures. 

A  Volume  of  Essays  on  the  Diagnosis,  Treatment,  etc.,  of  Diseases  of  the 
Nervous  System.  Cloth,  $2.00 

Epilepsy  and  Other  Chronic  Convulsive  Diseases. 

Second  Edition.  In  Press. 

Haig.     Causation  of  Disease  by  Uric  Acid.     Fifth  Edition. 

A  Contribution  to  the  Pathology  of  High  Arterial  Tension,  Headache,  Epilepsy, 
Mental  Depression,  Gout,  Rheumatism,  Diabetes,  Bright' s  Disease,  Anaemia,  etc. 
By  Alexander  Haig,  m.a.,  m.d.  (Oxon.),  f.r.c.p.,  Physician  to  Metropolitan  Hos- 
pital, London.     75  Illustrations.     Fifth  Edition.      8vo.     846  pages.         Cloth,  $3.00 

Diet  and  Food. 

Considered  in  Relation  to  Strength  and  Power  of  Endurance.  Third  Edition, 
Revised.     Just  Ready.  Cloth,  $1.00 


18  P.  BLAKISTON'S  SON  &-   CO.'S 

Hale.     On  the  Management  of  Children 
in  Health  and  Disease.  Cloth,  .50 

Hall.     Diseases  of  the  Nose  and  Throat. 

By  F.  DE  Havilland  Hall,  m.d.,  f.r.c.p.  (Lond.),  Physician  to  the  Westminster 
Hospital ;  President  of  the  Laryngological  Society  of  London  ;  Joint  Lecturer  on  the 
Principles  and  Practice  of  Medicine  at  the  Westminster  Hospital  ;  and  Herbert 
TiLLEY,  M.D.,  B.s.  (Lond.),  F.R.c.s.  (Eng.),  Surgeon  to  the  Throat  Hospital,  Golden 
Square  ;  Lecturer  on  Diseases  of  the  Nose  and  Throat,  London  Post-Graduate  College 
and  Polyclinic.  Second  Edition,  Thoroughly  Revised,  with  2  Plates  and  80  Illustra- 
tions. Cloth,  $2.75 

Hamilton.     Lectures  on  Tumors 

from  a  Chnical  Standpoint.  By  John  B.  Hamilton,  m.d.,  ll.d.,  late  Professor  of 
Surgery  in  Rush  Medical  College,  Chicago  ;  Professor  of  Surgery,  Chicago  Polyclinic  ; 
Surgeon  Presbyterian  Hospital,  etc.  Third  Edition,  Revised.  With  New  Illustra- 
tions.     i2mo.  '^  Cloth,  $1.25 

Hansell  and  Reber.     Muscular  Anomalies  of  the  Eye. 

By  Howard  F.  Hansell,  a.m.,  m.d.,  Clinical  Professor  of  Ophthalmology,  Jefferson 
Medical  College  ;  Professor  of  Diseases  of  the  Eye,  Philadelphia  Polyclinic,  etc. ;  and 
Wendell  Reber,  m.d..  Instructor  in  Ophthalmology,  Philadelphia  Polyclinic,  etc. 
With  I  Plate  and  28  other  Illustrations.      i2mo.  Cloth,  $1.50 

Hansell  and  Bell.     Clinical  Ophthalmology. 

By  Howard  F.  Hansell,  a.m.,  m.d.,  and  James  H.  Bell,  m.d.  With  Colored  Plate 
of  Normal  Fundus  and  120  Illustrations.      i2mo.  Cloth,  $1.50 

Hare.     Mediastinal  Disease. 

The  Pathology,  Clinical  History,  and  Diagnosis  of  Affections  of  the  Mediastinum 
other  than  those  of  the  Heart  and  Aorta.  By  H.  A.  Hare,  m.d..  Professor  of 
Materia  Medica  and  Therapeutics  in  Jefferson  Medical  College.     8vo.     Illustrated. 

Cloth,  $2.00 

Harlan.     Eyesight 

and  How  to  Care  for  It.  By  George  C.  Harlan,  m.d.,  Professor  of  Diseases  of 
the  Eye,  Philadelphia  Polyclinic.     Illustrated.  Cloth,  .40 

Harris'  Principles  and  Practice  of  Dentistry. 

Including  Anatomy,  Physiology,  Pathology,  Therapeutics,  Dental  Surgery,  and 
Mechanism.  By  Chapin  A.  Harris,  m.d.,  d.d.s.,  late  President  of  the  Baltimore 
Dental  College  ;  Author  of  ' '  Dictionary  of  Medical  Terminology  and  Dental  Sur- 
gery." Thirteenth  Edition,  Revised  and  Edited  by  Ferdinand  J.  S.  Gorgas, 
A.M.,  M.D.,  D.D.S.,  Author  of  "Dental  Medicine;"  Professor  of  the  Principles  of 
Dental  Science,  Oral  Surgery,  and  Dental  Mechanism  in  the  University  of  Maryland. 
1250  Illustrations.      11 80  pages.     Svo. 

Cloth,  $6.00  ;  Leather,  $7.00  ;  Half  Russia,  $8.00 

Dictionary  of  Dentistry. 

Including  Definitions  of  such  Words  and  Phrases  of  the  Collateral  Sciences  as 
Pertain  to  the  Art  and  Practice  of  Dentistry.  Sixth  Edition,  Rewritten,  Re- 
vised, and  Enlarged.  By  Ferdinand  J.  S.  Gorgas,  m.d.,  d.d.s.,  Author  of 
"  Dental  Medicine  ;"  Editor  of  Harris'  "Principles  and  Practice  of  Dentistry  ;" 
Professor  of  Principles  of  Dental  Science,  Oral  Surgery,  and  Prosthetic  Dentistry 
in  the  University  of  Maryland.     Octavo.  Cloth,  $5.00  ;  Leather,  $6.00 


MEDICAL  AND   SCIENTIFIC  PUBLICATIONS.  19 

Harris  and  Beale.     Treatment  of  Pulmonary  Consumption. 

By  Vincent  Dormer  Harris,  m.d.,  f.r.c.p.,  Physician  to  the  City  of  London  Hos- 
pital for  Diseases  of  the  Chest,  and  E.  Clifford  Beale,  m.a.,  f.r.c.p..  Physician  to 
the  City  of  London  Hospital  for  Diseases  of  the  Chest,  etc.      i2mo.         Cloth,  $2.50 

Hartridge.     Refraction. 

The  Refraction  of  the  Eye.  A  Manual  for  Students.  By  Gustavus  Hartridge, 
F.R.C.S.,  Senior  Surgeon  Royal  Westminster  Ophthalmic  Hospital;  Ophthalmic 
Surgeon  to  St.  Bartholomew's  Hospital,  etc.  105  Illustrations  and  Sheet  of  Test 
Types.     Tenth  Edition,  Revised  and  Enlarged  by  the  Author.  Cloth,  $1.50 

On  the  Ophthalmoscope. 

A  Manual  for  Physicians  and  Students.     Third  Edition.     With  Colored  Plates 
and  68  Wood-cuts.      i2mo.  Cloth,  $1.50 

Hartshorne.     Our  Homes. 

Their  Situation,  Construction,  Drainage,  etc.  By  Henry  Hartshorne,  m.d.  Illus- 
trated. Cloth,  .40 

Hatfield.     Diseases  of  Children. 

By  Marcus  P.  Hatfield,  Professor  of  Diseases  of  Children,  Chicago  Medical  Col- 
lege. With  a  Colored  Plate.  Second  Edition.  Being  No.  14  ?  Quiz- Compend  ? 
Series.      i2mo.  Cloth,  .80;  Interleaved  for  the  Addition  of  Notes,  $1.00 

"  Dr.  Hatfield  seems  to  have  most  thoroughly  appreciated  the  needs  of  students,  and  most 
excellently  has  he  condensed  his  matter  into  available  form.  It  is  in  accord  with  the  most  recent 
teachings,  and  while  brief  and  concise,  is  surprisingly  complete.  .  .  .  It  is  free  from  irritating 
repetition  of  questions  and  answers  which  mars  so  many  of  the  compends  now  in  use.  Written  in 
systematic  form,  the  consideration  of  each  disease  begins  with  its  definition,  and  proceeds  through 
the  usual  subheadings  to  prognosis  and  treatment,  thus  furnishing  a  complete,  readable  text-book." 
— Annals  of  Gynecology  and  Pediatry. 

Heath.     Minor  Surgery  and  Bandaging. 

By  Christopher  Heath,  f.r.c.s..  Holme  Professor  of  Clinical  Surgery  in  Univer- 
sity College,  London.  Eleventh  Edition,  Revised  and  Enlarged.  With  176  Illus- 
trations, Formulas,  Diet  List,  etc.      i2mo.  Cloth,  I1.25 

Practical  Anatomy. 

A  Manual  of  Dissections.     Eighth  London  Edition.     300  lUus.         Cloth,  $4.25 

Injuries  and  Diseases  of  the  Jaws. 
Fourth  Edition,  Edited  by  Henry  Percy  Dean,  m.s.,  f.r.c.s..  Assistant  Sur- 
geon London  Hospital.     With  187  Illustrations.     8vo.  Cloth,  $4- 5° 

Hedley.     Therapeutic  Electricity  and  Practical  Muscle  Testing. 

By  W.  S.  Hedley,  m.d.,  m.r.c.s.,  in  charge  of  the  Electrotherapeutic  Department 
of  the  London  Hospital.     99  Illustrations.     Octavo.  Cloth,  $2.50 

Heller.     Essentials  of  Materia  Medica,  Pharmacy,  and  Prescription 
Writing. 
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Medical  Institute,  University  of  Pennsylvania.      i2mo.  Cloth,  $1.50 

Henry.     Anaemia. 

A  Practical  Treatise.  By  Fred'k  P.  Henry,  m.d..  Physician  to  Episcopal  Hospital, 
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20  P.  BLAKISTON'S  SON  &-   CO.'S 

Hemmeter.     Diseases  of  the  Stomach.     Second  Edition. 

Their  Special  Pathology,  Diagnosis,  and  Treatment.  With  Sections  on  Anatomy, 
Analysis  of  Stomach  Contents,  Dietetics,  Surgery  of  the  Stomach,  etc.  By  John  C. 
Hemmeter,  m.d.,  philos.d..  Professor  in  the  Medical  Department  of  the  University 
of  Maryland  ;  Consultant  to  the  University  Hospital ;  Director  of  the  Clinical  Labor- 
atory, etc. ;  formerly  Clinical  Professor  of  Medicine  at  the  Baltimore  Medical  College, 
etc.  Second  Edition,  Enlarged  and  Thoroughly  Revised  and  in  parts  Rewritten. 
Colored  and  other  Illustrations.      Cloth,  $6.00  ;  Leather,  $7.00  ;  Half  Russia,  $8.00 

Diseases  of  the  Intestines. 
A  Complete  Systematic  Treatise  on   Diseases  of  the  Intestines,  including  the 
Surgical   Aspects   of  the'  subject.     Assisted  by  several  contributors  on  special 
subjects.     With  many  Full-page  Plates  and  other  Illustrations,  most    of  which 
are  Original.     Two  volumes.     Octavo.  Nearly  Ready. 

The  Section  on  Anatomy  has  been  prepared  by  Dr.  J.  Holmes  Smith,  Associate 
Professor  and  Demonstrator  of  Anatomy,  and  Lecturer  on  Clinical  Surgery,  University 
of  Maryland,  Baltimore.  The  Section  on  Bacteria  of  the  Intestines  has  been 
prepared  by  Dr.  Wm.  Royal  Stokes,  Associate  Professor  of  Pathology  and  Bacteriology, 
and  Visiting  Pathologist  to  the  University  Hospital,  University  of  Maryland,  Baltimore. 
The  Section  on  Diseases  of  the  Rectum  has  been  prepared  by  Dr.  Thomas  C. 
Martin,  Professor  of  Proctology,  Cleveland  College  of  Physicians  and  Surgeons.  The 
Section  on  Examination  of  Urine  and  Feces  has  been  prepared  by  Dr.  Harry 
Adler,  Demonstrator  of  Clinical  Pathology,  University  of  Maryland,  Baltimore.  The 
Illustrations  form  a  most  useful  and  practical  series  of  pictures, — nearly  all  have  been 
reproduced  from  pathological  preparations  and  original  drawings,  a  few  being  printed  in 
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Hewlett.     Manual  of  Bacteriology. 

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HoUopeter.     Hay  Fever  and  Its  Successful  Treatment. 

By  W.  C.  HOLLOPETER,  A.M.,  M.D.,  Clinical  Professor  of  Pediatrics  in  the  Medico- 
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Chirurgical,  and  St.  Joseph's  Hospitals,  etc.     Second  Edition,  Enlarged.      i2mo. 

Cloth,  $1.00 

Holden's  Anatomy.     Seventh  Edition. 

A  Manual  of  the  Dissections  of  the  Human  Body.  By  John  Langton,  f.r.c.s.. 
Surgeon  to,  and  Lecturer  on  Anatomy  at,  St.  Bartholomew's  Hospital.  Carefully 
Revised  by  A.  Hewson,  m.d.,  Demonstrator  of  Anatomy,  Jefferson  Medical  College, 
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Human  Osteology. 

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its  Development.  Eighth  Edition,  Carefully  Revised.  Edited  by  Charles 
Stewart,  f.r.s.,  and  R.  W.  Reid,  m.d.,  f.r.c.s.  With  Lithographic  Plates 
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Landmarks. 
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MEDICAL  AND   SCIENTIFIC  PUBLICATIONS.  21 

Holland.     The  Urine,  the  Gastric  Contents,  the  Common  Poisons, 
and  the  Milk.     Illustrated. 

Memoranda  (Chemical  and  Microscopical)  for  Laboratory  Use.  By  J.  W.  Holland, 
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Cloth,  $i.oo 

Horwitz's  Compend  of  Surgery. 

Including  Minor  Surgery,  Amputations,  Bandaging,  Fractures,  Dislocations,  Surgical 
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Treatment.  By  Orville  Horwitz,  b.s.,  m.d..  Professor  of  Genito-Urinary  Dis- 
eases, late  Demonstrator  of  Surgery,  Jefferson  Medical  College.  Fifth  Edition,  very 
much  Enlarged  and  Rearranged.  Over  300  pages.  167  Illustrations  and  98  For- 
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Horsley.     The  Brain  and  Spinal  Cord, 

the  Structure  and  Functions  of.  By  Victor  A.  Horsley,  m.b.,  f.r.s.,  etc.,  As- 
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Hovell.     Diseases  of  the  Ear  and  Naso-Pharynx. 

A  Treatise  including  Anatomy  and  Physiology  of  the  Organ,  together  with  the  treat- 
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T.  Mark  Hovell,  f.r.c.s.  (Edin.),  m.r.c.s.  (Eng.),  Aural  Surgeon  to  the  London 
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Humphrey.     A  Manual  for  Nurses.     Seventeenth  Edition. 

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Laurence  Humphrey,  m.a.,  m.b.,  m.r.c.s..  Assistant  Physician  to,  and  Lecturerat, 
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Hughes.     Compend  of  the  Practice  of  Medicine.     Sixth  Edition. 

Giving  the  Synonyms,  Definition,  Causes,  Symptoms,  Pathology,  Prognosis,  Diag- 
nosis, Treatment,  etc.,  of  each  Disease.  This  Treatment  is  especially  full  and  a 
number  of  valuable  Prescriptions  have  been  incorporated.  Sixth  Edition,  Revised 
and  Enlarged.  By  Daniel  E.  Hughes,  m.d..  Chief  Resident  Physician  Philadel- 
phia Hospital  ;  formerly  Demonstrator  of  Clinical  Medicine  at  Jefferson  Medical 
College,  Philadelphia.     Being  Nos.  2  and  j  ? Quiz- Compend?  Series. 

Quiz-Compend  Edition,  in  two  Parts. 

Part  I. — Continued,  Eruptive,  and  Periodical  Fevers,  Diseases  of  the  Mouth, 
Stomach,  Intestines,  Peritoneum,  Biliary  Passages,  Liver,  Kidneys,  Blood,  etc.. 
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Physicians'  Edition. 

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Idiocy,  Imbecility,  Insanity,  etc.  By  W.  W.  Ireland,  m.d.  (Edin.),  of  the  Home 
and  School  for  Imbeciles,  Mavisbush,  Scotland  ;  late  Medical  Supt.  Scot.  National 
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22  P.  BLAKISTON'S  SON  &-   CO.' S 

Jacoby.     Electrotherapy.     Illustrated. 
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Lecturer  on  Ophthalmic  Medicine  and  Surgery  at,  St.  Bartholomew's  Hospital,  Lon- 
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Jones.     Medical  Electricity.     Third  Edition. 

A  Practical  Handbook  for  Students  and  Practitioners  of  Medicine.  By  H.  Lewis 
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Keen.     Clinical  Charts. 

A  Series  of  Seven  Outline  Drawings  of  the  Human  Body,  on  which  may  be  marked 
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Kirkes'  Physiology.     Sixteenth  Edition. 

{The  only  Authorized  Edition.  i27no.  Dark  Red  Cloth.')  A  Handbook  of  Physiology. 
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F.R.S.,  Professor  of  Physiology,  King's  College,  London.  Thoroughly  Revised  and 
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Kenwood.     Public  Health  Laboratory  Work. 

By  H.  R.  Kenwood,  m.b.,  d.p.h.,  f.c.S.,  Instructor  in  Hygienic  Laboratory,  Univer 
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Kleen.     Handbook  of  Massage. 

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MEDICAL  AND   SCIENTIFIC  PUBLICATIONS.  23 

Kleen.     Diabetes  Mellitus  and  Glycosuria. 

Their  Diagnosis  and  Treatment.     See  preceding  title.     Octavo.  Cloth,   $2.50 

Knight.     Diseases  of  the  Throat. 

A  Manual  for  Students.  By  Charles  E.  Knight,  .m.d..  Professor  of  Laryngology, 
Cornell  University  Medical  College  ;  Surgeon  to  Throat  Department,  Manhattan  Eye 
and  Ear  Hospital,  etc.     Illustrated.  Nearly  Ready. 

Knopf.     Pulmonary  Tuberculosis.     Its  Modern  Prophylaxis  and  the 
Treatment  in  Special  Institutions  and  at  Home. 

By  S.  A.  Knopf,  m.d..  Physician  to  the  Lung  Department  of  the  New  York  Throat 
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Lake.      Laryngeal  Phthisis,  or  Consumption  of  the  Throat. 

By  Richard  Lake,   f.r.c.S.,    Surgeon  Laryngologist,    North  London   Hospital  for 
Consumption,  etc. ;  Surgeon,  Metropolitan  Ear  and  Throat  Hospital  ;  Surgeon,  Royal  • 
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Landis'  Compend  of  Obstetrics. 

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47  Illustrations.     No.  j  f  Quiz- Compend?  Series. 

Cloth,  .80  ;  Interleaved  for  the  Addition  of  Notes,  $1.00 

Landois.     A  Text-Book  of  Human  Physiology. 

Including  Histology  and  Microscopical  Anatomy,  with  Special  Reference  to  the  Re- 
quirements of  Practical  Medicine.  By  Dr.  L.  Landois,  Professor  of  Physiology  and 
Director  of  the  Physiological  Institute  in  the  University  of  Greifswald.  Fifth  Ameri- 
can translated  from  the  last  German  Edition,  with  Additions,  by  Wm.  Stirling, 
M.D.,  D.Sc,  Brackenbury  Professor  of  Physiology  and  Histology  in  Owens  College, 
and  Professor  in  Victoria  University,  Manchester  ;  Examiner  in  Physiology  in  Uni- 
versity of  Oxford,  England.  With  845  Illustrations,  many  of  which  are  printed  in 
Colors.     8vo.  In  Press. 

Lane.     Surgery  of  the  Head  and  Neck. 
By  L.  C.  Lane,  a.m.,  m.d.,  m.r.c.s.  (Eng.),  Professor  of  Surgery  in  Cooper  Medical 
College,  San  Francisco.     Second  Edition,  with  no  Illus.     Octavo.  Cloth,  ;f5.oo 

Lazarus-Barlow.     General  Pathology. 
By  W.  S.  Lazarus-Barlow,   m.d.,  Demonstrator  of  Pathology  at  the  University  of 
Cambridge,  England.     795  pages.     Octavo.  Cloth,  $5.00 

Lee.     The  Microtomist's  Vade  Mecum.     Fifth  Edition. 

A  Handbook  of  the  Methods  of  Microscopic  Anatomy.  By  Arthur  Bolles  Lee, 
formerly  Assistant  in  the  Russian  Laboratory  of  Zoology  at  Villefranche-sur-Mer  (Nice). 
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Cloth,  $4.00 

Leffmann  and  Beam.      Food  Analysis.     Illustrated. 

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\ 


24  P.  BLAKISTON'S  SON  &>   CO.' S 

Leffmann.     Compend  of  Medical  Chemistry. 

Inorganic  and  Organic.  Including  Urine  Analysis.  By  Henry  Leffmann,  m.d., 
Professor  of  Chemistry  in  the  Woman's  Medical  College  of  Pennsylvania  and  in  the 
Wagner  Free  Institute  of  Science,  Philadelphia  ;  Pathological  Chemist  Jefferson  Medi- 
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f  Quiz- Compend ?  Series.     Fourth  Edition,  Rewritten. 

Cloth,  .80  ;  Interleaved  for  the  Addition  of  Notes,  $1.00 

The  Coal-Tar  Colors. 

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Use.     A  Translation  of  Theodore  Weyl's  Monograph.      i2mo.  Cloth,  $1.25 

Examination  of  Water 

for  Sanitary  and  Technical  Purposes.     Fourth   Edition,  Enlarged.      Illustrated. 
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Analysis  of  Milk  and  Milk  Products. 

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Handbook  of  Structural  Formulae 

for  the  Use  of  Students,  containing  1 80  Structural  and  Stereo-chemic  Formulae. 
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Lewers.     On  the  Diseases  of  Women. 

A  Practical  Treatise.  By  Dr.  A.  H.  N.  Lewers,  Assistant  Obstetric  Physician  to 
the  London  Hospital.     146  Engravings.     Fifth  Edition,  Revised.  Cloth,  $2.50 

Lewis  (Bevan).     Mental  Diseases. 

A  Text-Book  having  Special  Reference  to  the  Pathological  Aspects  of  Insanity.  By 
Bevan  Lewis,  l.r.c.p.,  m.r.c.s..  Medical  Director  West  Riding  Asylum,  Wake- 
field, England.  26  Lithograph  Plates  and  other  Illustrations.  Second  Edition,  Re- 
vised and  Enlarged.     8vo.  Cloth,  $7.00 

Lincoln.     School  and  Industrial  Hygiene. 

By  D.  F.  Lincoln,  m.d.  Cloth,  .40 

Longley's  Pocket  Medical  Dictionary. 

Giving  the  Definition  and  Pronunciation  of  Words  and  Terms  in  General  Use  in 
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Macalister's  Human  Anatomy.      816  Illustrations. 

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Mackenzie.     The  Pharmacopceia  of  the   London  Hospital  for  Dis- 
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MEDICAL  AND   SCIENTIFIC  PUBLICATIONS.  25 

Macready.     A  Treatise  on  Ruptures. 

By  Jonathan  F.  C.  H.  Macready,  f.r.c.s.,  Surgeon  to  the  Great  Northern  Central 
Hospital ;  to  the  City  of  London  Hospital  for  Diseases  of  the  Chest ;  to  the  City  of 
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Mann.     Forensic  Medicine  and  Toxicology. 

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cology in  Owens  College,  Manchester  ;  Examiner  in  Forensic  Medicine  in  University 
of  London,  etc.     Illustrated.     Octavo.  Cloth,  $6.50 

Mann's  Manual  of  Psychological  Medicine 

and  Allied  Nervous  Diseases.  Their  Diagnosis,  Pathology,  Prognosis,  and  Treat- 
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an  Abstract  of  the  Laws  Relating  to  the  Insane  in  all  the  States  of  the  Union.  By 
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No.  I — The  Skeleton  and  Ligaments.  No.  2 — The  Muscles  and  Joints,  with  Ani- 
mal Mechanics.  No.  3 — The  Viscera  in  Position.  No.  4 — The  Heart  and  Principal 
Blood-vessels.  No.  5 — The  Lymphatics.  No.  6 — The  Digestive  Organs.  No.  7 — The 
Brain  and  Nerves.  Nos.  8  and  9 — The  Organs  of  the  Senses.  Nos.  10  and  11 — The 
Microscopic  Structure  of  the  Textures  and  Organs.     {Send  for  Special  Circular.) 

Matas.     Anesthesia  with  Cocain. 

Local  and  Regional  Anesthesia  with  Cocain,  Eucain,  and  other  Analgesic  Drugs, 
including  the  latest  methods.  By  Rudolph  Matas,  m.d.,  Professor  of  Surgery, 
Medical  Department  of  Tulane  University,  Louisiana  ;  Visiting  Surgeon  to  the  Charity 
Hospital,  New  Orleans,  etc.     With  Illustrations.  Nearly  Ready. 

Maxwell.     Terminologia  Medica  Polyglotta. 
By  Dr.  Theodore  Maxwell.     Octavo.  -  Cloth,  $3.00 

The  object  of  this  work  is  to  assist  the  medical  men  of  any  nationality  in  reading  medical 
literature  written  in  a  language  not  their  own.  Each  term  is  usually  given  in  seven  languages, 
viz.  :   English,  French,  German,  Italian,  Spanish,  Russian,  and  Latin. 

Maylard.     The  Surgery  of  the  Alimentary  Canal. 

By  Alfred  Ernest  Maylard,  m.b.,  b.s.,  Senior  Surgeon  to  the  Victoria  Infirmary, 
Glasgow.     Second  Edition.     97  Illustrations.     Octavo.  Cloth,  $3.00 

Mays'  Theine  in  the  Treatment  of  Neuralgia. 
By  Thomas  J.  Mays,  m.d.     i6mo.  %  bound,  .50 

McBride.     Diseases  of  the  Throat,  Nose,  and  Ear. 

A  Clinical  Manual  for  Students  and  Practitioners.  By  P.  McBride,  m.d.,  f.r.c.p. 
(Edin.),  Surgeon  to  the  Ear  and  Throat  Department  of  the  Royal  Infirmary  ;  Lec- 
turer on  Diseases  of  Throat  and  Ear,  Edinburgh  School  of  Medicine,  etc.  With 
Colored  Illustrations  from  Original  Drawings.  Third  Edition.  Thoroughly  Revised 
and  Enlarged.     Octavo.     Just  Ready.  Handsome  Cloth,  Gilt  Top,  $7.00 


26  P.  BLAKISTON'S  SON  (S^»   CO:  S 

McCook.     American  Spiders  and  Their  Spinning  Work. 

A  Natural  History  of  the  Orbweaving  Spiders  of  the  United  States.  By  Henry  C. 
McCooK,  D.D.,  Vice-President  of  the  Academy  of  Natural  Sciences  of  Philadelphia  ; 
Member  Entomological  Society  ;  Author  of  ' '  The  Agricultural  Ants  of  Texas, ' '  etc. 
Three  volumes.      Handsomely  Illustrated.  Cloth,  $50.00 

McNeill.     The  Prevention  of  Epidemics  and  the  Construction  and 

Management  of  Isolation  Hospitals. 

By  Dr.  Roger  McNeill,  Medical  Officer  of  Health  for  the  County  of  Argyll. 
With  Numerous  Plans  and  other  Illustrations.     Octavo.  Cloth,  $3. 50 

Meigs.      Milk  Analysis  and  Infant  Feeding. 

The  Examination  of  Human  and  Cow's  Milk,  Cream,  Condensed  Milk,  etc.,  and 
Directions  as  to  the  Diet  of  Young  Infants.     By  Arthur  V.  Meigs,  m.d.      i2mo. 

Cloth,  .50 

Memminger.     Diagnosis  by  the  Urine. 

The  Practical  Examination  of  Urine,  with  Special  Reference  to  Diagnosis.  By 
Allard  Memminger,  m.d..  Professor  of  Chemistry  and  Hygiene  ;  Clinical  Professor 
of  Urinary  Diagnosis  in  the  Medical  College  of  the  State  of  South  Carolina  ;  Visiting 
Physician  in  the  City  Hospital  of  Charleston,  etc.  Second  Edition,  Enlarged  and 
Revised.      24  Illustrations.      i2mo.  Cloth,  $1.00 

Montgomery.     A  Text-Book  of  Practical  Gynecology. 

By  Edward  E.  Montgomery,  m.d.,  Professor  of  Gynecology  in  Jefferson  Medical 

College,  Philadelphia;  Gynecologist  to  the  Jefferson  and  St.  Joseph's  Hospitals,  etc. 

527  Illustrations,  many  of  which   are  from  original  sources.     800  pages.     Octavo. 

Just  Ready.  Cloth,  $5.00;  Leather,  $6.00 

*^*  This  is  a  systematic  modern  treatise  on  Diseases  of  Women.  The  author's 
aim  has  been  to  produce  a  book  that  will  be  thorough  and  practical  in  every  particular. 
The  illustrations,  nearly  all  of  which  are  from  original  sources,  have  for  the  most  part 
been  drawn  by  special  artists  who,  for  a  number  of  months,  have  devoted  their  sole 
attention  to  this  work. 

Morris.     Text-Book  of  Anatomy.     Second  Edition.     790  Illustra- 
tions, many  in  Colors. 

A  Complete  Text-Book.  Edited  by  Henry  Morris,  f.r.c.s.,  Surgeon  to,  and  Lec- 
turer on  Anatomy  at,  Middlesex  Hospital,  assisted  by  J.  Bland  Sutton,  f.r.c.s., 
J.  H.  Davies-Colley,  f.r.c.s.,  Wm.  J.  Walsham,  f.r.c.s.,  H.  St.  John  Brooks, 
M.D.,  R.  Marcus  Gunn,  F.it.c.s.,  Arthur  Hensman,  f.r.c.s.,  Frederick  Treves, 
F.R.C.S.,  William  Anderson,  f.r.c.s.,  Arthur  Robinson,  m.d.,  m.r.c.s.,  and 
Prof.  W.  H.  A.  Jacobson.  One  Handsome  Octavo  Volume,  with  790  Illustrations, 
of  which  many  are  printed  in  Colors.      Thu7nb  Index  in  each  Copy. 

Cloth,  |6.oo  ;  Leather,  $7.00  ;  Half  Russia,  J8.00 

"  Of  all  the  text-books  of  moderate  size  on  human  anatomy  in  the  English  language,  Morris 
is  undoubtedly  the  most  up-to-date  and  accurate.  .  .  .  For  the  student,  the  surgeon,  or  for  the 
general  practitioner  who  desires  to  review  his  anatomy,  Morris  is  decidedly  the  book  to  buy." — 
The  Philadelphia  Medical  Journal. 

Handsome  circular,  with  sample  pages  and  colored  illustrations,  will  be  sent  free 
to  any  address. 

Renal  Surgery. 

With  Special  Reference  to  Stone  in  the  Kidney  and  Ureter,  and  to  the  Surgical 
Treatment  of  Calculous  Anuria,  together  with  a  Critical  Examination  of  Sub- 
parietal  Injuries  of  the  Ureter.     Illustrated.     8vo.  Cloth,  $2.00 

Mitchell  and  Gulick.     Mechanotherapy. 
See  Cohen,  Physiologic  Therapeutics,  page  10. 


MEDICAL  AND   SCIENTIFIC  PUBLICATIONS.  27 

Morton  on  Refraction  of  the  Eye. 

Its  Diagnosis  and  the  Correction  of  its  Errors.  With  Chapter  on  Keratoscopy  and 
Test  Types.     By  A.  Morton,  m.b.     Sixth  Edition,  Revised.  Cloth,  $i.oo 

Moullin.  Surgery.  Third  Edition,  by  Hamilton. 
A  Complete  Text-Book.  ByC.  W.  Maxsell  Moullin,  m.a.,  m.d.  (Oxon.),  f.r.c.s., 
Surgeon  and  Lecturer  on  Physiology  to  the  London  Hospital ;  formerly  Radcliffe 
Traveling  Fellow  and  Fellow  of  Pembroke  College,  Oxford.  Third  American 
Edition,  Revised  and  Edited  by  the  late  John  B.  Hamilton,  m.d.,  ll.d.,  Professor 
of  the  Principles  of  Surgery  and  Clinical  Surgery,  Rush  Medical  College,  Chicago  ; 
Professor  of  Surgery,  Chicago  Polyclinic  ;  Surgeon,  formerly  Supervising  Surgeon- 
General,  U.  S.  Marine  Hospital  Service  ;  Surgeon  to  Presbyterian  Hospital.  600 
Illustrations,  over  200  of  which  are  original,  and  many  of  which  are  printed  in 
Colors.     Royal  Octavo.      1250  pages. 

*^*  Circular  free.  Cloth,  $6.00;  Leather,  $7.00;  Half  Russia,  58.00 

Enlargement  of  the  Prostate. 

Its    Treatment   and    Radical    Cure.     Illustrated.     Second    Edition,    Enlarged. 
Octavo.  Cloth,  §1.75 

Inflammation  of  the  Bladder  and  Urinary  Fever. 

Octavo.  Cloth,  $1.50 

Muter.     Practical  and  Analytical  Chemistry. 

By  John  Muter,  f.r.s.,  f.c.s.,  etc.  Second  American  from  the  Eighth  EngHsh 
Edition.  Revised  to  meet  the  Requirements  of  American  Medical  and  Pharma- 
ceutical Colleges.      56  Illustrations.  Cloth,  $1.25 

New  Sydenham  Society  Publications. 

From  three  to  six  volumes  published  each  year.     List  of  Volutnes  upon  application. 

Per  annum,  $8.00 

Notter.     The  Theory  and  Practice  of  Hygiene.     Second  Edition. 

A  Complete  Treatise  by  J.  Lane  Notter,  m.a.,  m.d.,  f.c.s..  Fellow  and  Member 
of  Council  of  the  Sanitary  Institute  of  Great  Britain  ;  Professor  of  Hygiene,  Army 
Medical  School ;  Examiner  in  Hygiene,  University  of  Cambridge,  etc. ;  and  W.  H. 
HoRROCKS,  M.D.,  B.  Sc.  (Lond.),  Assistant  Professor  of  Hygiene,  Army  Medical 
School,  Netley.  Illustrated  by  15  Lithographic  Plates  and  138  other  Illustrations, 
and  including  many  Useful  Tables.  Second  Edition,  Carefully  Revised.  Octavo. 
1085  pages.  Cloth,  $7.00 

Oettel.     Practical  Exercises  in  Electro-Chemistry. 
By  Dr.  Felix  Oettel.     Auth(*rized  Translation  by  Edgar  F.  Smith,  m.a..  Professor 
of  Chemistry,  University  of  Pennsylvania.      Illustrated.  Cloth,  .75 

Introduction  to  Electro-Chemical  Experiments. 

Illustrated.     By  same  Author  and  Translator.  Cloth,  .75 

Ohlemann.     Ocular  Therapeutics  for  Physicians  and  Students. 

By  M.  Ohlemann,  m.d.,  late  Physician  in  the  Ophthalmological  Clinical  Institute, 
Royal  Prussian  University  of  Berlin,  etc.  Translated  and  Edited  by  Charles  A. 
Oliver,  a.  m.  ,  m.  d.  ,  Attending  Surgeon  to  the  Wills  Eye  Hospital ;  Ophthalmic  Surgeon 
to  the  Philadelphia  and  to  the  Presbyterian  Hospitals.      i2mo.  Cloth,  $1.75 

Ormerod.     Diseases  of  Nervous  System. 

By  J.  A.  Ormerod,  m.d.  (Oxon.),  f.r.c.p..  Physician  to  National  Hospital  for  the 
Paralyzed  and  Epileptic,  London.     66  Wood  Engravings.      i2mo.  Cloth,  $1.00 


28  P.  BLAKISTON'S  SON  &-   CO.'S 

Osgood.     The  Winter  and  Its  Dangers. 
By  Hamilton  Osgood,  m.d.  Cloth,  .40 

Osier  and  McCrae.     Cancer  of  the  Stomach. 

A  Clinical  Study.  By  William  Osler,  m.d.,  and  Thomas  McCrae,  m.b.  (Tor.),  of 
the  Johns  Hopkins  Hospital,  Baltimore.     With  Illustrations.     8vo.     Jusf  Ready. 

Cloth,  $2.00 

Osier.     Chorea  and  Choreiform  Affections. 

By  William  Osler,  m.d.,  f.r.c.p.  (Lond.),  Professor  of  Medicine,  Johns  Hopkins 
University,  etc.     8vo.  Cloth,  $2.00 

Ostrom.     Massage  and  the  Original  Swedish  Movements. 

Their  Application  to  Various  Diseases  of  the  Body.  A  Manual  for  Students,  Nurses, 
and  Physicians.  By  Kurre  W.  Ostrom,  from  the  Royal  University  of  Upsala, 
Sweden,  Instructor  in  Massage  and  Swedish  Movements  in  the  Hospital  of  the 
University  of  Pennsylvania  and  in  the  Philadelphia  Polyclinic  and  College  for  Gradu- 
ates in  Medicine,  etc.  Fourth  Edition,  Enlarged.  105  Illustrations,  many  of  which 
were  drawn  especially  for  this  purpose.      i2mo.  Cloth,  $1.00 

"  In  this  volume  the  author  gives  an  excellent  description  of  the  methods  of  massage  and 
Swedish  movements,  together  with  their  applicabihty  to  various  diseased  conditions  of  the  body. 
The  methods  are  rapidly  becoming  popularized  in  our  own  country,  and  the  perusal  of  such  a  book 
as  Mr.  Ostrom  has  written  will  be  of  great  advantage  to  physicians,  for  whose  use  it  is  mainly 
intended." — The  Journal  of  the  American  Medical  Association. 

Packard's  Sea  Air  and  Sea  Bathing. 
By  John  H.  Packard,  m.d.  Cloth,  .40 

Parkes.     Hygiene  and  Public  Health. 

A  Practical  Manual.  By  Louis  C.  Parkes;  m.d.,  d.p.h.  (Lond.  Univ.),  Lecturer 
on  Public  Health  at  St.  George's  Hospital;  Medical  Officer  of  Health  and  Public 
Analyst,  Borough  of  Chelsea,  London,  etc.;  and  Henry  Kenwood,  m.b.,  f.c.s.. 
Assistant  Professor  of  Public  Health,  University  College,  London,  etc.  Sixth  Edition, 
Enlarged  and  Revised.     85  Illustrations.      i2mo.     Just  Ready.  Cloth,  $3.00 

"  The  style  is  good ;  dry  facts,  laws,  and  statistics  are  put  in  such  a  way  that  the  reader  does 
not  tire  of  them  and  yet  finds  them  easy  to  lemember. " — University  Medical  Magazine. 

The  Elements  of  Health. 

An  Introduction  to  the  Study  of  Hygiene.     Illustrated.  Cloth,  $1.25 

Phillips.     Spectacles  and  Eyeglasses. 

Their  Prescription  and  Adjustment.  By  R.  J.  PhilCips,  m.d..  Instructor  in  Diseases 
of  the  Eye,  Philadelphia  Polyclinic  ;  Ophthalmic  Surgeon,  Presbyterian  Hospital. 
Second  Edition,  Revised  and  Enlarged.     49  Illustrations.      i2mo.  Cloth,  $1.00 

"  This  little  work  now  appears  in  the  form  of  a  revised  second  edition.  It  is  of  convenient 
size  and  is  excellently  printed.  The  book  is  issued  as  an  aid  to  those  who  prescribe  and  who 
sell  eyeglasses  and  spectacles,  for  the  purpose  of  enabling  them  to  reach  the  most  satisfactory 
and  beneficial  results  in  the  adjustment  of  lenses  to  the  eyes  of  patients.  Since  the  proper  adjust- 
ment of  spectacles  and  eyeglasses  is  of  very  great  importance,  it  is  desirable  that  the  rules  and 
suggestions  contained  in  this  little  volume  should  be  familiar  to  every  oculist  and  optician.'" — The 
Medical  Record,  New  York. 

"  This  excellent  manual,  which  has  received  its  second  edition,  continues  to  be  the  best  book 
on  the  subject  of  which  it  treats.  It  should  be  read  by  every  one  who  is  interested  in  that  most 
important  portion  of  the  ophthalmic  surgeon's  work — the  supervision  of  the  proper  adjustment  of 
spectacles.  It  is  doubly  useful  for  those  practitioners  of  ophthalmology  who  are  unable  to  command 
the  services  of  a  skilled  optician." — The  American  Journal  of  the  Medical  Sciences,  Philadelphia. 


MEDICAL  AND   SCIENTIFIC  PUBLICATIONS.  29 

The  Physician's  Visiting  List. 

Published  Annually.     Fiftieth  Year  (1901)  of  its  Publication. 

Hereafter  all  styles  will  contain  the  interleaf  or  special  memoranda  page,  except 
the  Monthly  Edition,  and  the  sizes  for  75  and  100  Patients  will  come  in  two  volumes 
only. 

REGULAR    EDITION. 


For  25 

Patients 

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pocket  and  pencil.  Gilt  Edges,  $1.00 

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' '     2  vols. 

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2.00 

75 

" 

"      2  vols. 

1  Jan.  to  June  )  ,, 
\  July  to  Dec.  j 

"                "           "        "          2.00 

100 

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"      2  vols. 

Jan.  to  June  1  ,, 
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' 2.25 

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without  Dates  and  with  Special  Memorandum  Pages. 

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Extra  Pencils 

will  be  sent,  postpaid,  for  25  cents  per  half  dozen. 

This  list  combines  the  several  essential  qualities  of  strength,   compactness. 


durability,  and  convenience.  It  is  made  in  all  sizes  and  styles  to  meet  the  wants  of  all 
physicians.  It  is  not  an  elaborate,  complicated  system  of  keeping  accounts,  but  a 
plain,  simple  record,  that  may  be  kept  with  the  least  expenditure  of  time  and  trouble — 
hence  its  popularity.  A  special  circular,  descriptive  of  contents,  will  be  sent  upon 
application. 

Potter.     A  Handbook  of  Materia  Medica,  Pharmacy,  and  Thera- 
peutics.    Eighth  Edition,  Enlarged. 

Including  the  Action  of  Medicines,  Special  Therapeutics  of  Disease,  Official  and 
Practical  Pharmacy,  and  Minute  Directions  for  Prescription  Writing,  etc.  Including 
over  600  Prescriptions  and  Formulae.  By  Samuel  O.  L.  Potter,  m.a.,  m.d.,  m.r.c.p. 
(Lond.),  formerly  Professor  of  the  Principles  and  Practice  of  Medicine,  Cooper  Medical 
College,  San  Francisco  ;  Major  and  Brigade  Surgeon,  U.  S.  Vol.  Eighth  Edition, 
Revised  and  Enlarged.  8vo.  950  pages.  Just  Ready. 
With  Thumb  Index  in  each  copy.     Cloth,  I5.00  ;  Leather,  $6.00  ;  Half  Russia,  $7.00 

Compend  of  Anatomy,  including  Visceral  Anatomy. 

Sixth  Edition,   Revised  and  greatly  Enlarged.     With    16  Lithographed  Plates 
and  117  other  Illustrations.     Being  A^o.  i  f  Quiz- Compend  f  Series. 

Cloth,  .80;  Interleaved  for  Taking  Notes,  $1.00 

Compend   of    Materia   Medica,   Therapeutics,  and   Prescription 
Writing. 

With  Special  Reference  to  the  Physiological  Action  of  Drugs.     Sixth  Revised  and 
Improved  Edition,  with  Index.     Being  No.  6  f  Quiz- Compend?  Series. 

Cloth,  .80  ;  Interleaved  for  Taking  Notes,  51.00 


30  P.  BLAKISTON'S  SON  <&-   CO:  S 

Potter.     Speech  and  Its  Defects. 

Considered  Physiologically,  Pathologically,  and  Remedially  ;  being  the  Lea  Prize 
Thesis  of  Jefferson  Medical  College,  1882.     Revised  and  Corrected.      i2mo. 

Cloth,  $1.00 

Power.     Surgical  Diseases  of  Children 

and  their  Treatment  by  Modern  Methods.  By  D'Arcy  Power,  m.a.,  f.r.c.s. 
(Eng.),  Demonstrator  of  Operative  Surgerj^  St.  Bartholomew's  Hospital  ;  Surgeon 
to  the  Victoria  Hospital  for  Children.     Illustrated.      i2mo.  Cloth,  $2.50 

Preston.     Hysteria  and  Certain  Allied  Conditions. 

Their  Nature  and  Treatment.  With  Special  Reference  to  the  Application  of  the  Rest 
Cure,  Massage,  Electrotherapy,  Hypnotism,  etc.  By  George  J.  Preston,  m.d., 
Professor  of  Diseases  of  the  Nervous  System,  College  of  Physicians  and  Surgeons, 
Baltimore  ;  Visiting  Physician  to  the  City  Hospital ;  Consulting  Neurologist  to  Bay 
View  Asylum  and  the  Hebrew  Hospital ;  Member  American  Neurological  Associa- 
tion, etc.     Illustrated.      i2mo.  Cloth,  $2.00 

Pritchard.     Handbook  of  Diseases  of  the  Ear. 

By  Urban  Pritchard,  m.d.,  f.r.c.s..  Professor  of  Aural  Surgery,  King's  College, 
London  ;  Aural  Surgeon  to  King's  College  Hospital ;  Senior  Surgeon  to  the  Royal 
Ear  Hospital,  etc.     Third  Edition.     Many  Illustrations  and  Formulae.      i2mo. 

Cloth,  $1.50 

Proctor's  Practical  Pharmacy. 

Lectures  on  Practical  Pharmacy.  By  Barnard  S.  Proctor.  Third  Edition,  Re- 
vised.   With  Elaborate  Tables  of  Chemical  Solubilities,  etc.     Illustrated.    Cloth,  $3.00 

Reese's  Medical  Jurisprudence  and  Toxicology. 

A  Text-Book  for  Medical  and  Legal  Practitioners  and  Students.  By  John  J.  Reese, 
M.D.,  Editor  of  "Taylor's  Jurisprudence,"  formerly  Professor  of  the  Principles  and 
Practice  of  Medical  Jurisprudence,  including  Toxicology,  in  the  University  of  Pennsyl- 
vania Medical  Department.  Fifth  Edition,  Revised  and  Edited  by  Henry  Leffmann, 
M.D.,  Pathological  Chemist,  Jefferson  Medical  College  Hospital ;  Chemist,  State  Board 
of  Health  ;  Professor  of  Chemistry^  Woman's  Medical  College  of  Pennsylvania,  etc. 
i2mo.     645  pages.  Cloth,  $3.00;  Leather,  $3.50 

"To  the  student  of  medical  jurisprudence  and  toxicology  it  is  invaluable,  as  it  is  concise, 
clear,  and  thorough  in  every  respect." — The  American  Journal  of  the  Medical  Sciences. 

Reeves.     Medical  Microscopy. 

Including  Chapters  on  Bacteriology,  Neoplasms,  Urinary  Examination,  etc.  By 
James  E.  Reeves,  m.d.,  ex-President  American  Public  Health  Association,  etc. 
Numerous  Illustrations,  some  of  which  are  printed  in  Colors.      i2mo.       Cloth,  $2.50 

Regis.     Mental  Medicine. 

A  Practical  Manual.  By  Dr.  E.  Regis,  formerly  Chief  of  Clinique  of  Mental  Dis- 
eases, Faculty  of  Medicine  of  Paris  ;  Physician  of  the  Maison  de  Sante  de  Castel 
d'Andorte.  With  a  Preface  by  M.  Benjamin  Ball,  Clinical  Professor  of  Mental 
Diseases,  Faculty  of  Medicine,  Paris.  Authorized  Translation  by  H.  M.  Bannister, 
M.D.,  late  Senior  Assistant  Physician,  Illinois  Eastern  Hospital  for  the  Insane,  etc. 
With  an  Introduction  by  the  Author.      i2mo.  Cloth,  $2.00 

Richardson.     Long  Life 

and  How  to  Reach  It.  By  J.  G.  Richardson,  formerly  Professor  of  Hygiene,  Uni- 
versity of  Pennsylvania.  Cloth,  .40 


MEDICAL  AND   SCIENTIFIC  PUBLICATIONS.  31 

Richardson's  Mechanical  Dentistry. 

A  Practical  Treatise  on  Mechanical  Dentistry.  By  Joseph  Richardson,  d.d.s. 
Seventh  Edition,  Thoroughly  Revised  and  in  many  parts  Rewritten  by  Geo.  W. 
Warren,  a.m.,  d.d.s..  Professor  of  Clinical  Dentistry  and  Oral  Surgery;  Chief  of 
the  Clinical  Stafif,  Pennsylvania  College  of  Dental  Surgery,  Philadelphia.  With  691 
Illustrations,  many  of  which  are  from  Original  Wood  Engravings.  Octavo.  675 
pages.  Cloth,  $5. 00  ;  Leather,  $6.00  ;  Half  Russia,  $7.00 

Richter's  Inorganic  Chemistry. 

A  Text-Book  for  Students.  By  Prof.  Victor  von  Richter,  University  of  Breslau. 
Fifth  American  from  Tenth  German  Edition  by  Prof.  H.  Klinger,  University  of 
Konigsberg.  Authorized  Translation  by  Edgar  F.  Smith,  m.a.,  ph.d.,  Sc.d., 
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Cloth,  $1.75 

Organic  Chemistry. 

The  Chemistry  of  the  Carbon  Compounds.  Third  American  Edition,  Translated 
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PH.D.,  Sc.d.,  Professor  of  Chemistry,  University  of  Pennsylvania.  Revised 
and  Enlarged.     Illustrated.      i2mo.     Two  volumes. 

Vol.    I.     Aliphatic  Series.     625  pages.  Cloth,  $3.00 

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Robinson.     Latin  Grammar  of  Pharmacy  and  Medicine. 

By  D.  H.  Robinson,  ph.d..  Professor  of  Latin  Language  and  Literature,  University 
of  Kansas.  Introduction  by  L.  E.  Sayre,  ph.g..  Professor  of  Pharmacy  and 
Dean  of  the  Department  of  Pharmacy  in  University  of  Kansas.  Third  Edition, 
Revised  with  the  help  of  Prof.  L.  E.  Sayre,  of  University  of  Kansas,  and  Dr. 
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"  This  method  of  preparing  medical  students  and  pharmacists  for  a  practical  use  of  the  lan- 
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"  It  is  practical ;  its  arrangement  shows  the  careful  and  thoughtful  genius  of  its  author,  who 
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the  pupil  rapidly  to  an  understanding  of  what  he  had  feared  would  be  uninteresting  and  tedious." 
— Phannaceutical  Record. 

St.  Clair.     Medical  Latin. 

Designed  Expressly  for  the  Elementary  Training  of  Medical  Students.  By  W.  T. 
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Sayre.     Organic  Materia  Medica  and  Pharmacognosy. 

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Schamberg.     Compend  of  Diseases  of  the  Skin. 

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Fellow  of  the  College  of  Physicians  of  Philadelphia  ;  Quiz-Master  at  University  of 
Pennsylvania.  Second  Edition,  Revised  and  Enlarged.  105  Illustrations.  ?  Quiz- 
Compend?  Series,  No.  16.  Cloth,  .80;    Interleaved,  $1.00 


32  P.  BLAKISTON'S  SON  &^  CO.' S 

Schreiner.     Diet  List. 

Arranged  in  the  Form  of  a  Chart  on  which  Articles  of  Diet  can  be  Indicated  for  any 
Disease.  By  E.  R.  Schreiner,  m.d.,  Assistant  Demonstrator  of  Physiology,  Uni- 
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Per  Pad,  .75 

Scott.     The  Urine :   Its  Chemical  and  Microscopical  Examination. 

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Scoville.     The  Art  of  Compounding,     Second  Edition. 

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Self-Examination  for  Medical  Students. 

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Smith.     Abdominal  Surgery.     Sixth  Edition. 

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Smith.     Electro-Chemical  Analysis. 

By  Edgar  F.  Smith,  m.a.,  ph.d.,  sc.d..  Professor  of  Chemistry,  University  of 
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Smith  and  Keller.     Experiments. 

Arranged  for  Students  in  General  Chemistry.  By  Edgar  F.  Smith,  m.a.,  ph.d., 
Sc.d.,  Professor  of  Chemistry,  University  of  Pennsylvania,  and  Dr.  H.  F.  Keller, 
Professor  of  Chemistry,  Philadelphia  High  School.  Fourth  Revised  Edition.  8vo. 
Illustrated.     Just  Ready.  Cloth,  .60 

Smith.     Dental  Metallurgy. 
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Smith.     Wasting  Diseases  of  Infants  and  Children. 

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MEDICAL  AND   SCIENTIFIC  PUBLICATIONS.  33 

Starling.     Elements  of  Human  Physiology. 

By  Ernest  H.  Starling,  m.d.  (Lond.),  m.r.c.p.,  Joint  Lecturer  on  Physiology  at 
Guy's  Hospital,  London,  etc.     With  loo  Illus.      i2mo.     437  pages.        Cloth,  $1.00 

Starr.     The  Digestive  Organs  in  Childhood. 

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the  Investigation  of  Disease  and  the  Management  of  Children.  By  Louis  Starr, 
M.D.,  late  Clinical  Professor  of  Diseases  of  Children  in  the  Hospital  of  the  University 
of  Pennsylvania ;  Physician  to  the  Children's  Hospital,  Philadelphia.  Third 
Edition.     Illustrated.     Octavo.  Preparing. 

The  Hygiene  of  the  Nursery. 

Including  the  General  Regimen  and  Feeding  of  Infants  and  Children,  and  the 
Domestic  Management  of  the  Ordinary  Emergencies  of  Early  Life,  Massage,  etc. 
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Stearns.      Lectures  on  Mental  Diseases. 

By  Henry  Putnam  Stearns,  m.d.,  Physician-Superintendent  at  the  Hartford  Retreat ; 
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Stevenson  and  Murphy.     A  Treatise  on  Hygiene. 

By  Various  Authors.     Edited  by  Thomas  Stevenson,   m.d.,  f.r.c.p.,   Lecturer  on 

Chemistry  and  Medical  Jurisprudence  at  Guy's  Hospital,  London,  and  Shirley  F. 

Murphy,   Medical  Officer  of   Health  to  the  County  of  London.     In  three  octavo 

volumes. 

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Vol.  III.     Sanitary  Law.     Octavo.  Cloth,  $5.00 

***  special  Circular  upon  application. 

Stewart's  Compend  of  Pharmacy. 

Based  upon  "Remington's  Text-Book  of  Pharmacy."  By  F.  E.  Stewart,  m.d., 
ph.g.,  late  Quiz-Master  in  Chemistry  and  Theoretical  Pharmacy,  Philadelphia  College 
of  Pharmacy  ;  Lecturer  on  Pharmacology,  Jefferson  Medical  College.  Fifth  Edition. 
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Series.  Cloth,  .80  ;  Interleaved  for  the  Addition  of  Notes,  $1.00 

Stirling.     Outlines  of  Practical  Physiology. 

Including  Chemical  and  Experimental  Physiology,  with  Special  Reference  to  Practical 
Medicine.  By  W.  Stirling,  m.d.,  Scd.,  Professor  of  Physiology  and  Histology, 
Owens  College,  Victoria  University,  Manchester  ;  Examiner  in  Physiology,  Univer- 
sities of  Edinburgh  and  London.     Third  Edition.     289  Illustrations.        Cloth,  $2.00 

Outlines  of  Practical  Histology. 

368  Illustrations.  Second  Edition,  Revised  and  Enlarged.  With  new  Illustra- 
tions.     i2mo.  Cloth,  ^2.00 


84  P.  BLAKISTON'S  SON  &-   CO.' S 

Stohr.  Text-Book  of  Histology,  Including  the  Microscopical 
Technic.  301  Illustrations. 
By  Dr.  Philip  Stohr,  Professor  of  Anatomy  at  University  of  Wurzburg.  Author- 
ized Translation  by  Emma  L.  Bilstein,  m.d.,  formerly  Demonstrator  of  Histology, 
Woman's  Medical  College  of  Penna.  Edited,  with  Additions,  by  Dr.  Alfred 
SCHAPER,  Professor  of  Anatomy,  University  of  Breslau ;  formerly  Demonstrator  of 
Histology,  Harvard  Medical  School,  Boston.  Third  American  from  the  Eighth  German 
Edition,  Enlarged  and  Revised.      301  Illustrations.     Octavo.  Cloth,  $3.00 

"This  edition  of  an  alreadywell-known  student's  manual  requires  little  but  favorable  com- 
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work's  position  more  secure.  The  book  is  not  only  a  useful  one  for  the  student,  but  makes  a  very 
good  work  of  reference  for  its  subject,  and  is  thus  entitled  to  a  place  upon  the  shelves  of  the  prac- 
titioner. ' ' —  The  Medical  Record,  New  York. 

Sturgis.     Manual  of  Venereal  Diseases.     Seventh  Edition. 

By  F.  R.  Sturgis,  M.t).,  Sometime  Clinical  Professor  of  Venereal  Diseases  in  the 
Medical  Department  of  the  University  of  the  City  of  New  York  ;  formerly  one  of 
the  Visiting  Surgeons  to  Charity  Hospital,  Blackwells  Island,  Department  of  Vene- 
real Diseases  ;  Member  of  the  American  Association  of  Genito-Urinary  Surgeons,  etc. 
Seventh  Edition,  Revised  and  in  part  Rewritten  by  F.  R.  Sturgis,  m.d.,  and  Follen 
Cabot,  m.d..  Instructor  in  Genito-Urinary  and  Venereal  Diseases  in  the  Cornell  Uni- 
versity Medical  College  ;  Genito-Urinary  Out-Patient  Surgeon  to  Bellevue  Hospital ; 
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Just  Ready.  Cloth,  $1.25 

Sutton's  Volumetric  Analysis. 

A  Systematic  Handbook  for  the  Quantitative  Estimation  of  Chemical  Substances  by 
Measure,  Applied  to  Liquids,  Solids,  and  Gases.  Adapted  to  the  Requirements  of 
Pure  Chemical  Research,  Pathological  Chemistry,  Pharmacy,  Metallurgy,  Photog- 
raphy, etc.,  and  for  the  Valuation  of  Substances  Used  in  Commerce,  Agriculture, 
and  the  Arts.  By  Francis  Sutton,  f.c.s.  Eighth  Edition,  Revised  and  Enlarged. 
With  116  Illustrations.     8vo.     Just  Ready.  Cloth,  $5.00 

Swain.     Surgical  Emergencies. 

Together  with  the  Emergencies  Attendant  on  Parturition  and  the  Treatment  of  Poison- 
ing. By  William  Paul  Swain,  f.r.c.s.,  Surgeon  to  the  South  Devon  and  East 
Cornwall  Hospital,  England.     Fifth  Edition.      149  Illustrations.      i2mo. 

Cloth,  $1.75 

Swanzy.     Diseases  of  the  Eye  and  their  Treatment. 

A  Handbook  for  Physicians  and  Students.  By  Henry  R.  Swanzy,  a.m.,  m.b., 
F.R.C.S. I.,  Examiner  in  Ophthalmology,  University  of  Dublin  ;  Surgeon  to  the  National 
Eye  and  Ear  Infirmary  ;  Ophthalmic  Surgeon  to  the  Adelaide  Hospital,  Dublin. 
Seventh  Edition,  Thoroughly  Revised  and  Enlarged.  165  Illustrations,  one  Plain 
Plate,  and  a  Zephyr  Test  Card.      i2mo.  Cloth,  $2.50 

"  Is  without  doubt  the  most  satisfactory  manual  we  have  upon  diseases  of  the  eye.  It  occu- 
pies the  middle  ground  between  the  students'  manuals,  which  are  too  brief  and  concise,  and  the 
encyclopedic  treatises,  which  are  too  extended  and  detailed  to  be  of  special  use  to  the  general 
practitioner." — Chicago  Medical  Recorder. 

Symonds.     Manual  of  Chemistry 

for  Medical  Students.  By  Brandreth  Symonds,  a.m.,  m.d..  Assistant  Physician 
Roosevelt  Hospital,  Out-Patient  Department,  New  York.     Second  Edition.      i2mo. 

Cloth,  $2.00 

Taft.     Index  of  Dental  Periodical  Literature. 

By  Jonathan  Taft,  d.d.s.     8vo.  Cloth,  $2.00 


MEDICAL  AND   SCIENTIFIC  PUBLICATIONS.  35 

Tanner's  Memoranda  of  Poisons 

and  their  Antidotes  and  Tests.  By  Thos.  Hawkes  Tanner,  m.d.  Eighth  Edition, 
Revised  by  Henry  Leffmann,  m.d.,  Professor  of  Chemistry,  Woman's  Medical  Col- 
lege of  Penna. ;  Vice-President  Society  of  Public  Analysts.      i2mo.  Cloth,  .75 

Taylor.     Practice  of  Medicine. 

By  Frederick  Taylor,  m.d..  Physician  to,  and  Lecturer  on  Medicine  at,  Guy's 
Hospital,  London  ;  Physician  to  Evelina  Hospital  for  Sick  Children.     Fifth  Edition. 

Cloth,  $4.00 

Taylor  and  Wells.  Diseases  of  Children.  Illustrated. 
A  Manual  for  Students  and  Physicians.  By  John  Madison  Taylor,  a.b.,  m.d.. 
Professor  of  Diseases  of  Children,  Philadelphia  Polyclinic  ;  Pediatrist  to  the  Philadel- 
phia Hospital  ;  Assistant  Physician  to  the  Children's  Hospital  and  to  the  Orthopedic 
Hospital  ;  Consulting  Physician  to  the  Elwyn  and  the  Vineland  Training  Schools  for 
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H.  Wells,  m.d..  Adjunct  Professor  of  Obstetrics  and  Diseases  of  Infancy  in  the 
Philadelphia  Polyclinic  ;  Demonstrator  of  Clinical  Obstetrics,  Jefferson  Medical  Col- 
lege ;  Chief  Gynecologist,  Mt.  Sinai  Hospital.  With  Numerous  Illustrations.  Second 
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Temperature  Charts 

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Thayer.     Compend  of  Pathology. 

Specially  adapted  for  Medical  Students  and  Physicians.  By  A.  E.  Thayer,  m.d.. 
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Thorington.     Retinoscopy.      Fourth  Edition. 

(The  Shadow  Test)  in  the  Determination  of  Refraction  at  One  Meter  Distance  with 
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Eye  in  the  Philadelphia  Polyclinic  ;  Ophthalmologist  to  the  Elwyn,  Vineland,  and 
New  Jersey  State  Training  Schools  for  Feeble-minded  Children  ;  Lecturer  on  the 
Anatomy,  Physiology,  and  Care  of  the  Eyes  in  the  Philadelphia  Manual  Training 
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Refraction  and  How  to  Refract.     Second  Edition. 

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Synopsis  of  Contents. — I.  Optics.  II.  The  Eye  ;  The  Standard  Eye  ; 
Cardinal  Points  ;  Visual  Angle  ;  Minimum  Visual  Angle  ;  Standard  Acuteness  of 
Vision  ;  Size  of  Retinal  Image,  Accommodation  ;  Mechanism  of  Accommoda- 
tion ;  Far  and  Near  Point ;  Determination  of  Distant  Vision  and  Near  Point  ; 
Amplitude  of  Accommodation  ;  Convergence  ;  Angle  Gamma  ;  Angle  Alpha. 
III.  Ophthalmoscope  ;  Direct  and  Indirect  Method.  IV.  Emmetropia  ;  Hyper- 
opia ;  Myopia.  V.  Astigmatism  or  Curvature  Ametropia  ;  Tests  for  Astigma- 
tism. VI.  Retinoscopy.  VII.  Muscles.  VIII.  Cycloplegics  ;  Cycloplegia  ; 
Asthenopia ;  Examination  of  the  Eyes.  IX.  How  to  Refract.  X.  Applied 
Refraction.  XI.  Presbyopia ;  Aphakia ;  Anisometropia ;  Spectacles.  XII. 
Lenses  ;  Spectacle  and  Eye  Glass  Frames  ;  How  to  Take  Measurements  for 
Them  and  How  They  Should  be  Fitted.     Index. 


86  P.  BLAKISTON'S  SON  6^»   CO:  S 

Thorne.     The   Schott   Methods  of  the  Treatment  of  Chronic  Dis- 
eases of  the  Heart. 

With  an  Account  of  the  Nauheim  Baths  and  of  the  Therapeutic  Exercises.  By  W. 
Bezly  Thorne,  m.d.,  m.r.c.p.  With  Plates  and  Numerous  other  Illustrations. 
Third  Edition,  Revised  and  Enlarged.     Octavo.  Cloth,  $1.75 

Tissier.      Pneumatotherapy  and  Inhalation  Methods. 

See  Cohen,  Physiologic  Therapeutics,  page  10. 

Tomes'  Dental  Anatomy. 

A  Manual  of  Dental  Anatomy,  Human  and  Comparative.  By  C.  S.  Tomes,  d.d.s. 
263  Illustrations.     Fifth  Edition.  i2mo.  Cloth,  $4.00 

Dental  Surgery. 

A  System  of  Dental  Sin-gery.  By  John  Tomes,  f.r.s.  Fourth  Edition,  Thor- 
oughly Revised  by  C.  S.  Tomes,  d.d.s.  With  289  Illustrations.  limo.  717 
pages.  Cloth,  $4.00 

Treves.     German-English  Medical  Dictionary. 

By  Frederick  Treves,  f.r.c.s.,  assisted  by  Dr.  Hugo  Lang,  b.a.  (Munich). 
i2mo.  Half  Calf,  $3.25 

Physical  Education  :  Its  Effects,  Value,  Methods,  etc.     8vo. 

Cloth,  .75 
Tuke.     Dictionary  of  Psychological  Medicine. 

Giving  the  Definition,  Etymology,  and  Synonyms  of  the  Terms  used  in  Medical  Psy- 
chology, with  the  Symptoms,  Pathology,  and  Treatment  of  the  Recognized  Forms  of 
Mental  Disorders,  together  with  the  Law  of  Lunacy  in  Great  Britain  and  Ireland. 
Edited  by  D.  Hack  Tuke,  m.d.,  ll.d..  Examiner  in  Mental  Physiology  in  the  Uni- 
versity of  London.     Two  volumes.     Octavo.  Cloth,  $10.00 

"  A  comprehensive,  standard  book." — The  British  Medical  Journal. 

"  It  is  vastly  more  than  a  Dictionary.  It  is  an  elaborate  and  complete  Encyclopaedia  of 
Psychological  Medicine ;  in  fact,  a  small  library  in  itself  on  that  subject.  The  high  expectations 
which  Dr.  Take's  work  in  this  field  had  raised  are  more  than  fulfilled.  ...  It  will  be  found 
to  be  a  most  useful  reference  handbook  for  the  alienist  and  student.  The  general  physician  also 
cannot  fail  to  find  the  book  exceedingly  useful  in  special  cases." — Boston  Medical  and  Surgical 
Journal. 

"We  believe  that  the  student  might  obtain  a  better  knowledge  of  insanity  from  this  work  than 
from  most  of  the  text-books,  besides  a  great  deal  of  interesting  and  valuable  information  nowhere 
else  accessible." — American  Journal  of  Insanity. 

Traube.     Physico-Chemical  Methods. 

By  Dr.  J.  Traube,  Privatdocent  in  the  Technical  High  School  of  Berlin.  Author- 
ized Translation  by  W.  D.  Hardin,  Harrison  Senior  Fellow  in  Chemistry,  University 
of  Pennsylvania.     With  97  Illustrations.     8vo.  Cloth,  ^1.50 

Thresh.     Water  and  Water  Supplies. 

By  John  C.  Thresh,  d.sc.  (Lond.),  m.d.,  d.p.h.  (Cambridge),  Medical  Officer  of 
Health  to  the  Essex  County  Council  ;  Lecturer  on  Public  Health,  King's  College, 
London  ;  Fellow  of  the  Institute  of  Chemistry  ;  Member  Society  Public  Analysts, 
etc.     Second  Edition,  Revised.     Illustrated.     438  pages.      i2mo.  Cloth,  $2.00 

Turnbull's  Artificial  Anesthesia. 

A  Manual  of  Anesthetic  Agents  in  the  Treatment  of  Diseases,  also  their  Employment 
in  Dental  Surgery  ;  Modes  of  Administration  ;  Considering  their  Relative  Risks  ; 
Tests  of  Purity  ;  Treatment  of  Asphyxia  ;  Spasms  of  the  Glottis  ;  Syncope,  etc.  By 
Laurence  Turnbull,  m.d.,  ph.g..  Aural  Surgeon  to  Jefferson  College  Hospital,  etc. 
Fourth  Edition,  Revised.      54  Illustrations.      i2mo.  Cloth,  $2.50 


MEDICAL  AND   SCIENTIFIC  PUBLICATIONS.  37 

Tuson.     Veterinary  Pharmacopoeia. 

Including  the  Outlines  of  Materia  Medica  and  Therapeutics.  By  Richard  V. 
Tuson,  late  Professor  at  the  Royal  Veterinary  College.  Fifth  Edition,  Edited  by 
James  Bayne,  f.c.s.,  Professor  of  Chemistry  and  Toxicology  at  the  Royal  Veterinary 
College.      l2mo.  Cloth,  ^^2.25 

Tyson.     The  Practice  of  Medicine.     Second  Edition.     Just  Ready. 

A  Text-Book  for  Physicians  and  Students,  with  Special  Reference  to  Diagnosis  and 
Treatment.  By  James  Tyson,  m.d..  Professor  of  Medicine  in  the  University  of 
Pennsylvania;  Physician  to  the  University  and  to  the  Philadelphia  Hospitals,  etc. 
With  Colored  Plates  and  many  other  Illustrations.  Second  Edition,  Revised  and 
Enlarged.      127  Illustrations.     8vo.      1222  pages. 

Cloth,  $5.50;  Leather,  $6.50;  Half  Russia,  $7.50 
*^*  This  edition  has  been  entirely  reset  from  new  type.     The  author  has  revised  it 
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"  This  work  not  only  represents  the  work  of  a  practitioner  of  great  experience,  but  of  a  care- 
ful culling  of  the  facts  set  forth  in  contemporary  literature  by  one  who  well  understands  the  art  of 
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"  Represents  the  outcome  of  much  well-directed  labor,  and  constitutes  a  reliable  and  useful 
text- book." — The  London  Lancet. 

"  Few  teachers  in  the  country  can  claim  a  longer  apprenticeship  in  the  laboratory  and  at  the 
bedside,  none  a  more  intimate  acquaintance  with  students,  since  in  one  capacity  or  another  he  has 
been  associated  with  the  University  of  Pennsylvania  and  the  Philadelphia  Hospital  for  nearly  thirty 
years.  Moreover,  he  entered  medicine  through  the  portal  of  pathology,  a  decided  advantage  in 
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*^*  Sample  Pages  and  Illustrations  sent  free  upon  application. 

Guide  to  the  Examination  of  Urine. 

For  the  Use  of  Physicians  and  Students.  With  Colored  Plate  and  Numerous 
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Handbook  of  Physical  Diagnosis. 

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278  pages.      i2mo.  Cloth,  $1.50 

Cell  Doctrine. 

Its  History  and  Present  State.     Second  Edition,  Cloth,  $1.50 

United  States  Pharmacopoeia. 

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Select  Tables  from  the  U.  S.  P. 

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Ulzer  and  Fraenkel.  Introduction  to  Chemical-Technical  Analysis. 
By  Prof.  F.  Ulzer  and  Dr.  A.  Fraenkel,  Directors  of  the  Testing  Laboratory  of 
the  Royal  Technological  Museum,  Vienna.  Authorized  Translation  by  Hermann 
Fleck,  nat.sc.d..  Instructor  in  Chemistry  and  Chemical  Technical  Analysis  in  the 
John  Harrison  Laboratory  of  Chemistry,  University  of  Pennsylvania,  with  an 
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trations.    8vo.  Cloth,  $1.25 


88  P.  BLAKISTON'S  SON  &*   CO.' S 

Van  Nuys  on  the  Urine. 

Chemical  Analysis  of  Healthy  and  Diseased  Urine,  Qualitative  and  Quantitative.  By 
T.  C.  Van  Nuys.      39  Illustrations.     Octavo.  Cloth,  $1.00 

Van  Harlingen  on  Skin  Diseases. 

A  Practical  Manual  of  Diagnosis  and  Treatment,  with  Special  Reference  to  Differential 
Diagnosis.  By  Arthur  Van  Harlingen,  m.d..  Emeritus  Professor  of  Diseases  of 
the  Skin  in  the  Philadelphia  Polyclinic  ;  Dermatologist  to  the  Children's  Hospital. 
Third  Edition,  Revised  and  Enlarged.  With  Formulas  and  Illustrations,  several  being 
in  Colors.      580  pages.  Cloth,  J2.75 

"  As  would  naturally  be  expected  from   the  author,  his  views  are  sound,  his  information 

extensive,  and  in  matters  of  practical  detail  the  hand  of  the  experienced  physician  is  everywhere 

visible. "  —  77^1?  Medical  News. 

Virchow's  Post-mortem  Examinations. 

A  Description  and  Explanation  of  the  Method  of  Performing  them  in  the  Dead- 
House  of  the  Berlin  Charite  Hospital,  with  Especial  Reference  to  Medico-Legal 
Practice.  By  Professor  Virchow.  Translated  by  Dr.  T.  P.  Smith.  Illustrated. 
Third  Edition.  Cloth,'  .75 

Voswinkel.     Surgical  Nursing. 

A  Manual  for  Nurses.  By  Bertha  M.  Voswinkel,  Graduate  Episcopal  Hospital, 
Philadelphia;  late  Nurse-in-Charge  Children's  Hospital,  Columbus,  O.  Second 
Edition,  Revised  and  Enlarged,      iii  Illustrations.     i2mo.  Cloth,  $1.00 

Walker.     Students'  Aid  in  Ophthalmology. 

By  Gertrude  A.  Walker,  a.b.,  m.d.,  CHnical  Instructor  in  Diseases  of  the  Eye  at 
Woman's  Medical  College  of  Pennsylvania.  40  Illustrations  and  Colored  Plate. 
i2mo.  Cloth,  $1.50 

Walsham.     Surgery  :    Its  Theory  and  Practice.     Seventh  Edition. 

For  Students  and  Physicians.  By  Wm.  J.  Walsham,  m.d.,  f.r.c.s.,  Senior  Assist- 
ant Surgeon  to,  and  Demonstrator  of  Practical  Surgery  in,  St.  Bartholomew's  Hospital  ; 
Surgeon  to  Metropolitan  Free  Hospital,  London.  Seventh  Edition,  Revised  and  En- 
larged by  100  pages.     With  483  Illustrations  and  28  Skiagrams.     Just  Ready. 

Cloth,  I3.50 

Ward.     Notes  on  Massage. 

Including  Elementary  Anatomy  and  Physiology.  By  Jessie  M.  Ward,  Instructor  in 
Massage  in  the  Pennsylvania,  Philadelphia,  Jefferson,  and  Woman's  Hospitals,  etc. 
i2mo.     Interleaved.  Paper  Cover,  $1.00 

Warren.     Compend  of  Dental  Pathology  and  Dental  Medicine. 

Containing  all  the  most?  Noteworthy  Points  of  Interest  to  the  Dental  Student  and  a 
Chapter  on  Emergencies.  By  George  W.  Warren,  d.d.s..  Professor  of  Clinical 
Dentistry  and  Oral  Surgery  ;  Clinical  Chief,  Pennsylvania  College  of  Dental  Surgery, 
Philadelphia.  Third  Edition,  Enlarged.  Illustrated.  Being  No.  13  ?  Quiz- Com- 
pend f  Series.      i2mo.  Cloth,  .80;  Interleaved  for  the  Addition  of  Notes,  $1.00 

Dental  Prosthesis  and  Metallurgy. 

129  Illustrations.  Cloth,  $1.25 

Weber     and     Hinsdale.      Climatology — Health    Resorts — Mineral 
Springs. 
See  Cohen,  Physiologic  Therapeutics,  page  10. 


MEDICAL  AND   SCIENTIFIC  PUBLICATIONS.  39 

Wells.     Compend  of  Gynecology. 

By  Wm.  H.  Wells,  m.d.,  Demonstrator  of  Clinical  Obstetrics,  Jefferson  Medical 
College,  Philadelphia  ;  Chief  Gynecologist  Mt.  Sinai  Hospital  ;  Fellow  of  the  College 
of  Physicians  of  Philadelphia.  Second  Edition,  Revised.  140  Illustrations.  Being 
No.  7  ?  Quiz- Compend  f  Series.      i2mo.         Cloth,  .80;  Interleaved  for  Notes,  $1.00 

Wethered.     Medical  Microscopy. 

A  Guide  to  the  Use  of  the  Microscope  in  Practical  Medi«ine.  By  Frank  J.  Weth- 
ered, M.D.,  M.R.C.P.,  Demonstrator  of  Practical  Medicine,  Middlesex  Hospital  Med- 
ical School ;  Assistant  Physician,  late  Pathologist,  City  of  London  Hospital  for 
Diseases  of  the  Chest,  etc.  With  a  Colored  Plate  and  loi  Illustrations.  406  pages. 
i2mo.  Cloth,  ;g2.oo 

Weyl.     Sanitary  Relations  of  the  Coal-Tar  Colors. 

By  Theodore  Weyl.  Authorized  Translation  by  Henry  Leffmann,  m.d.,  ph.d. 
i2mo.  Cloth,  $1.25 

Whitacre.     Laboratory  Text-Book  of  Pathology. 

By  Horace  J.  Whitacre,  m.d.,  Demonstrator  of  Pathology,  Medical  College  of 
Ohio,  Cincinnati.  Illustrated  with  121  Original  Drawings  and  Microphotographs. 
8vo.  Cloth,   $1.50 

White.     The  Mouth  and  Teeth.     Illustrated. 

By  J.  W.  White,  m.d.,  d.d.s.  Cloth,  .40 

White  and  Wilcox.     Materia  Medica,  Pharmacy,  Pharmacology,  and 
Therapeutics.     Fourth  Edition. 

A  Handbook  for  Students.  By  W.  Hale  White,  m.d.,  f.r.c.p.,  etc..  Physician  to, 
and  Lecturer  on  Materia  Medica  and  Therapeutics,  Guy's  Hospital ;  Examiner  in 
Materia  Medica  to  the  Conjoint  Board,  etc.  Fourth  American  Edition,  Revised  by 
Reynold  W.  Wilcox,  m.a.,  m.d.,  ll.d..  Professor  of  CHnical  Medicine  and  Thera- 
peutics at  the  New  York  Post-Graduate  Medical  School  and  Hospital ;  Visiting  Phy- 
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Edition,  Thoroughly  Revised.      i2mo.  Cloth,  $3.00;  Leather,  $3.50 

Williams.     Manual  of  Bacteriology.     Second  Edition. 

By  Herbert  U.  Williams,  m.d..  Professor  of  Pathology  and  Bacteriology,  Medical 
Department,  University  of  Buffalo.     Second  Edition,  Revised.     90  Illus.      i2mo. 

Cloth,  $1.50 

Wilson.     Handbook  of  Hygiene  and  Sanitary  Science. 

By  George  Wilson,  m.a.,  m.d.,  f.r.s.e..  Medical  Officer  of  Health  for  Mid- War- 
wickshire, England.    With  Illustrations.    Eighth  Edition.     i2mo.  Cloth,  ^3.00 

Wilson.     The  Summer  and  its  Diseases. 

By  James  C.  Wilson,  m.d..  Professor  of  the  Practice  of  Medicine  and  Clinical 
Medicine,  Jefferson  Medical  College,  Philadelphia.  Cloth,  .40 

Wilson.     System  of  Human  Anatomy. 

Eleventh  Revised  Edition,  Edited  by  Henry  Edward  Clark,  m.d.,  m.r.c.s.  492 
Illustrations,  26  Colored  Plates,  and  a  Glossary  of  Terms.      i2mo.  Cloth,  $5.00 

Winckel.     Text-Book  of  Obstetrics. 

Including  the  Pathology  and  Therapeutics  of  the  Puerperal  State.  By  Dr.  F. 
Winckel,  Professor  of  Gynecology,  Royal  University  Chnic  for  Women  in  Munich. 
Authorized  Translation  by  J.  Clifton  Edgar,  a.m.,  m.d.,  Professor  of  Obstetrics 
and  Clinical  Midwifery,  Cornell  University  Medical  Department,  New  York.  190 
Illustrations.     Octavo.  Cloth,  $5.00  ;  Leather,  $6.00 


40  P.  BLAKISTON'S  SON  <S-   CO: S  PUBLICATIONS. 

Windle.     Surface  Anatomy  and  Landmarks. 

By  B.  C.  A.  Windle,  Sc.d.,  m.d.,  Professor  of  Anatomy  in  Mason  College,  Bir- 
mingham, etc.  Second  Edition,  Revised  by  T.  Manners  Smith,  m.r.c.s.  Colored 
and  other  Illustrations.      i2mo.  Cloth,  ;5i.oo 

Winternitz.     Hydrotherapy — Thermotherapy — Balneology. 

See  Cohen,  Physiologic  Therapeutics,  page  lo. 

• 

Wood.     Brain  Work  and  Overwork. 

By  H.  C.  Wood,  Clinical  Professor  of  Nervous  Diseases,  University  of  Pennsylvania. 
i2mo.  Cloth,  .40 

Woody.     Essentials  of  Medical  and  Clinical  Chemistry. 

With  Laboratory  Exercises.  By  Samuel  E.  Woody,  a.m.,  m.d.,  Professor  of  Chem- 
istry and  Diseases  of  Children  in  the  Medical  Department,  Kentucky  University, 
Louisville.     Fourth  Edition,  Revised  and  Enlarged.     Illustrated.    laino.    Cloth,  $1.50 

"  The  fact  that  Prof.  Woody's  little  book  has  reached  a  third  edition  in  such  a  short  time  is 
sufficient  proof  of  its  usefulness  for,  and  demand  by,  the  medical  student.  The  selection  of  the 
material  and  its  plan  of  presentation,  resulting  from  the  author's  large  experience  as  a  practitioner 
and  teacher  of  medical  chemistry,  is  well  intended  to  offer  to  the  student  that  which  is  really  essen- 
tial for  his  limited  college  course,  and,  it  is  to  be  hoped,  a  basis  for  further  instruction  in  the  impor- 
tant branch  of  medical  science." — The  American  Journal  of  Medical  Sciences,  Philadelphia. 

Wright.     Ophthalmology.     New  Edition.     117  Illustrations. 

A  Text-Book  by  John  W.  Wright,  a.m.,  m.d.,  Professor  of  Ophthalmology  and 
Clinical  Ophthalmology  in  Ohio  Medical  University  ;  Ophthalmologist  to  the  Protest- 
aiit  and  University  Hospitals,  etc.  Second  Edition,  Revised,  Rewritten,  and  Enlarged. 
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THE  STANDARD  TEXT-BOOK 

Morris'  Anatomy 

Second  Edition,  Enlarged  and  Improved 

790  Illustrations,  of  which  2J4  arc  O>lofed 

Octavo.    1274  Pages.    Cloth,  $6.00  j  Leather,  $7.00 

"  Morris'  Anatomy"  was  published  at  a  time  when  methods  0/ teaching, 
the  art  of  engraving,  and  distinct  advance  in  anatomical  illustration 
made  desirable  a  new  and  modem  text-book.  The  rapid  sale  of  the  first 
edition,  its  immediate  adoption  as  a  text-book  by  a  large  number  of  medi- 
cal schools,  and  its  purchase  by  physicians  and  surgeons  proved  its  value 
and  made  it  from  the  day  of  publication  a  standard  authority. 

In  making  this  new  edition  the  editors  and  publishers  have  used  every 
endeavor  to  enhance  its  value.  The  text  has  been  thoroughly  revised  and 
in  many  parts  rewritten ;  the  editor  has  devoted  himself  to  the  task  of 
making  it  a  harmonious  whole;  many  new  illustrations  have  replaced 
those  used  in  the  first  edition,  and  a  large  number  have  been  printed  in 
colors,  while  the  typographical  appearance  has  been  improved  in  several 
particulars. 

The  illustrations,  in  correctness  and  excellence  of  execution,  are  equaled 
by  no  similar  treatise;  about  jjSiooo  having  been  expended  on  new  and 
improved  blocks  for  this  edition  alone. 

***  CIRCULAR  WITH  SAMPLE  PAGES  AND  ILLUSTRATIONS  FREE. 

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From  the  Soatbern  Clinic. 

"  We  know  of  no  series  of  books  issued  by  any  house  that  so  fully  meets  our  approval  as  these 
?  Quiz-Compends  ?.  They  are  well  arranged,  full,  and  concise,  and  are  really  the  best  line  of  text- 
books that  could  be  found  for  either  student  or  practitioner." 


BLAKISTON'S  ?QUIZ=COMPENDS? 

The  Best  Series  of  Manuals  for  the  Use  of  Students. 

Price  of  each,  Cloth,  .80.       Interleaved  for  taking  Notes,  81.00. 

g^'These  Compends  are  based  on  the  most  popular  text-books  and  the  lectures  of  prominent 
professors,  and  are  kept  constantly  revised,  so  that  they  may  thoroughly  represent  the  present  state 
of  the  subject  upon  which  they  treat.  The  authors  have  had  large  experience  as  Quiz-Masters 
and  attaches  of  colleges,  and  are  well  acquainted  with  the  wants  of  students.  They  are  arranged 
in  the  most  approved  form,  thorough  and  concise,  containing  about  800  illustrations,  inserted 
wherever  they  could  be  used  to  advantage.  Can  be  used  by  students  of  anj>  college,  and  contain 
information  nowhere  else  collected  in  such  a  condensed  practical  shape. 

ILLUSTRATED  CIRCULAR    FREE. 

No.  I.  HUMAN  ANATOMY.  Sixth  Revised  and  Enlarged  Edition.  Including  Vis- 
ceral Anatomy.  Can  be  used  with  either  Morris's  or  Gray's  Anatomy.  117  Illustrations  and 
16  Lithographic  Plates  of  Nerves  and  Arteries,  with  Explanatory  Tables,  etc.  By  Samuel 
O.  L.  Potter,  m.d. ,  formerly  Professor  of  the  Practice  of  Medicine,  Cooper  Medical  College, 
San  Francisco;   Major  and  Brigade  Surgeon,  U.  S.  Vol. 

No.  2.  PRACTICE  OF  MEDICINE.  Part  I.  Sixth  Edition,  Revised,  Enlarged,  and 
Improved.  By  Dan'l  E.  Hughes,  m.d.,  Physician-in-Chief,  Philadelphia  Hospital;  late 
Demonstrator  of  Clinical  Medicine,  Jefferson  Medical  College,  Philadelphia. 

No.  3.  PRACTICE  OF  MEDICINE.  Part  II.  Sixth  Edition,  Revised,  Enlarged,  and 
Improved.     Same  author  as  No.  2. 

No.  4.  PHYSIOLOGY.  Tenth  Edition,  with  new  Illustrations.  Enlarged  and  Revised. 
By  A.  P.  Brubaker,  m.d..  Professor  of  Physiology  in  the  Pennsylvania  College  of  Dental 
Surgery;  Adjunct  Professor  of  Physiology,  Jefferson  Medical  College,  Philadelphia. 

No.  5.  OBSTETRICS.  Sixth  Edition.  By  Henry  G.  Landis,  m.d.  Revised  and  Edited 
by  Wm.  H.  Wells,  m.d..  Instructor  of  Obstetrics,  Jefferson  Medical  College,  Philadelphia. 
Enlarged.     3  Plates  and  47  other  Illustrations. 

No.  6.  MATERIA  MEDIC  A,  THERAPEUTICS,  AND  PRESCRIPTION 
WRITING.     Sixth  Revised  Edition.     Same  author  as  No.  i. 

No.  7.  GYNECOLOGY.  Second  Edition.  By  Wm.  H.  Wells,  m.d.,  Instructor  of  Obstet- 
rics, Jefferson  Medical  College,  Philadelphia.     140  Illustrations. 

No.  8.  DISEASES  OF  THE  EYE  AND  REFRACTION.  Second  Edition.  Includ- 
ing Treatment  and  Surgery  and  a  Section  on  Local  Therapeutics.  By  George  M.  Gould, 
m.d.,  Editor  Philadelphia  Medical  Journal,  2Xidi  W.  L.  Pyle,  M.d.  ,  Assistant  Surgeon,  Wills 
Eye  Hospital.      With  Formulae,  Glossary,  several  useful  Tables,  and  109  Illustrations. 

No.  9.  SURGERY,  Minor  Surgery,  and  Bandaging.  Fifth  Edition,  Enlarged  and  Im- 
proved. By  Orville  Horwitz,  B.S.,  m.d.,  Clinical  Professor  of  Genito- Urinary  Surgery 
and  Venereal  Diseases  in  Jefferson  Medical  College  ;  Surgeon  to  Philadelphia  Hospital,  etc. 
With  98  Foimulae  and  167  Illustrations. 

No.  10.  MEDICAL  CHEMISTRY.  Fourth  Edition.  Including  Urinalysis,  Chemistry  of 
Milk,  Blood,  etc.  By  Henry  Leffmann,  m.d.,  Professor  of  Chemistry  in  Pennsylvania 
College  of  Dental  Surgery  and  in  tlie  Woman's  Medical  College,  Philadelphia. 

No.  II.  PHARMACY.  Fifth  Edition.  Based  upon  Professor  Remington's  Text-Book  of 
Pharmacy.  By  F.  E.  .Stewart,  m.d.,  ph.g.,  late  Quiz-Master  in  Pharmacy  and  Chemistry, 
Philadelphia  College  of  Pharmacy ;  Lecturer  at  Jefferson  Medical  College. 

No.  12.  VETERINARY  ANATOMY  AND  PHYSIOLOGY.  Illustrated.  By  Wm. 
R.  Ballou,  m.d..  Professor  of  Equine  Anatomy  at  New  York  College  of  Veterinary  Sur- 
geons;  Physician  to  Bellevue  Dispensary,  etc.     With  29  graphic  Illustrations. 

No.  13.  DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE.  Third  Edition, 
Illustrated.     By  George  W.  Warre.x,  D.d.S.,  Pennsylvania  College  of  Dental  Surgery. 

No.  14.  DISEASES  OF  CHILDREN.  Colored  Plate.  By  Marcus  P.  Hatfield, 
Professor  of  Diseases  of  Children,  Chicago  Medical  College.     Second  Edition,  Enlarged. 

No.  15.     GENERAL  PATHOLOGY.  Illustrated.    By  A.  E.  Thayer,  m.d.,  etc.  Preparing. 

No.  16.  DISEASES  OF  THE  SXIN.  By  Jay  F.  Schamberg,  m.d.  Professor  of  Skin 
Diseases,  Philadelphia  Polyclinic.      Second  Edition,  Revised.      105  Illustrations. 

No.  17.     HISTOLOGY.     Illustrated.     By  H.  H.  Gushing,  m.d.  Preparing. 

41 


JUST  READY,  ONE  VOLUME 

A  Cyclopedia  of  Practical 
Medicine  and  Surgery 

A  CONCISE   REFERENCE   BOOK,  ALPHABETICALLY 

ARRANGED 

OF 

MEDICINE,  SURGERY,  OBSTETRICS,  MATERIA  MEDICA,  THERAPEUTICS, 

AND  THE  VARIOUS  SPECIALTIES,  WITH  PARTICULAR 

REFERENCE  TO  DIAGNOSIS  AND  TREATMENT 

COMPILED  UNDER  'THE  EDITORIAL  SUPERVISION  OF 


GEORGE  M,  GOULD,  M.D.   AND   WALTER  L.  PYLE,  M.D. 

ithorof  "  An  Illustrated  Dictionary  of  Medicine  J  "  Assistant  Surgeon  Wills  Eye  Hospital;  formei 

Editor  "  Philadelphia  Medical  Journal,"  etc.  Editor  "  International  Medical  Magazine,"  et( 

AND  SEVENTY-TWO  SPECIAL  CONTRIBUTORS 


WITH  MANY  ILLUSTRATIONS 


LARGE  SQUARE  OCTAVO.  TO  CORRESPOND  ^3^TH  GOULD'S  *'  ILLUSTRATED 
DICTIONARY."  FULL  SHEEP  OR  HALF  DARK-GREEN  LEATHER,  $10.00? 
WITH    THUMB   INDEX,    $IJ.OO?      HALF    RUSSIA,    THUMB  INDEX,    $12.00,    NET 

The  great  success  of  Dr.  Gould' s  ' '  Illustrated  Dictionary  of  Medicine  ' '  suggested 
the  preparation  of  this  companion  volume,  which  should  be  to  the  physician  the  same 
trustworthy  handbook  in  the  broad  field  of  general  information  that  the  Dictionary  is 
in  the  more  special  one  of  the  explanation  of  words  and  the  statement  of  facts.  The 
aim  has  been  to  provide  in  a  one-volume  book  all  the  material  usually  contained  in 
the  large  systems  and  much  which  they  do  not  contain.  Instead  of  long  discursive 
papers  on  special  subjects  there  are  short,  concise,  pithy  articles  alphabetically 
arranged,  giving  the  latest  methods  of  diagnosis,  treatment,  and  operating — a  working 
book  in  which  the  editors  and  their  collaborators  have  condensed  all  that  is  essential 
from  a  vast  amount  of  literature  and  personal  experience. 

The  illustrations  have  been  selected  with  care,  only  those  having  been  used  that  are 
of  practical  value  ;  no  effort  has  been  made  to  overload  the  book  with  useless  pictures. 

The  seventy-two  special  contributors — the  names  of  whom  are  given  on  the 
following  page — have  been  selected  from  all  parts  of  the  country  in  accordance 
with  their  fitness  for  treating  special  subjects  about  which  they  may  be  considered 
expert  authorities.  They  are  all  men  of  prominence,  teachers,  investigators,  and 
writers  of  experience,  who  give  to  the  book  a  character  unequaled  by  any  other  work 
of  the  kind, 

V  LARGE  DESCRIPTIVE  CIRCULAR  UPON  APPLICATION 

42 


GOULD  AND  PYLE'S 

CYCLOPEDIA  OF  MEDICINE 


LIST   OF  CONTRIBUTORS 


Samuel  W.  Abbott,  A.M.,  M.D.,  Boston. 

James  M.  Anders,  M.D.,  LL.D.,  Phila. 

Joseph  D.  Bryant,  M.D.,  New  York. 

James  B.  Bullitt,  M.D.,  Louisville. 

Charles  H.  Burnett,  A.M.,  M.D.,  Phila, 

J.  Abbott  Cantrell,  M.D.,  Philadelphia. 

Archibald  Church,  M.D.,  Chicago. 

L.  Pierce  Clark,  M.D.,  Sonyea,  N.  Y. 

Solomon  Solis-Cohen,  M.D.,  Philadelphia. 

Nathan  S.  Davis,  Jr.,  M.D.,  Chicago. 

Theodore  Diller,  M.D.,  Pittsburg. 

Augustus  A.  Eshner,  M.D.,  Philadelphia. 

J.  T.  Eskridge,  M.D.,  Denver,  Col. 

J.  McFadden  Gaston,  A. B.,  M.D.,  Atlanta, 
Ga. 

J.  McFadden  Gaston,  Jr.,  A.M.,  M.D.,  At- 
lanta, Ga. 

Virgil  P.  Gibney,  M.D.,  New  York. 

George  M.  Gould,  A.M.,  M.D.,  Phila. 

W.  A.  Hardaway,  A.M.,  M.D.,  St.  Louis. 

John  C.  Hemmeter,  M.B.,  M.D.,  Baltimore. 

Barton  Cooke  Hirst,  M.D.,  Philadelphia. 

Bayard  Holmes,  M.D.,  Chicago. 

Orville  Horwitz,  B.S.,  M.D.,  Philadelphia. 

Daniel  E.  Hughes,  M.D.,  Philadelphia. 

James  Nevins  Hyde,  A.M.,  M.D.,  Chicago. 

E.  Fletcher  Ingals,  A.M.,  M.D.,  Chicago. 

Abraham  Jacobi,  M.D.,  New  York. 

William  W.  Johnston,  M.D.,  Washington, 
D.  C. 

Wyatt  Johnston,  M.D.,  Montreal. 

Allen  A.Jones,  M.D.,  Buffalo. 

William  W.  Keen,  M.D.,  LL.D.,  Phila. 

Howard  S.  Kinne,  M.D.,  Philadelphia. 

Ernest  Laplace,  M.D.,  Philadelphia. 

Benjamin  Lee,  M.D.,  Philadelphia. 

Charles  L.  Leonard,  M.D.,  Philadelphia. 

James  Hendrie  Lloyd,  A.M.,  M.D.,  Phila. 

J.  W.  MacDonald,  M.D.  (Edin.),  F.R.C.S. 
Ed.,  Minneapolis. 

L.  S.  McMurtry,  M.D.,  Louisville. 

G.  Hudson  Makuen,  Philadelphia. 

43 


Matthew  D.  Mann,  M.D.,  Buffalo. 

Henry    O.    Marcy,    A.M.,    M.D.,    LL.D., 

Boston. 
Rudolph  Matas,  M.D.,  New  Orleans. 
Joseph  M.  Mathews,  M.D.,  Louisville. 
John  K.  Mitchell,  M.D.,  Philadelphia. 
Harold  N.  Moyer,  M.D.,  Chicago. 
John  H.  Musser,  M.D.,  Philadelphia. 
A.  G.  Nicholls,  M.D.,  Montreal. 

A.  H.     Ohmann-Dusmesnil,     M.D.,     St. 
Louis. 

William  Osier,  M.D.,  Baltimore. 

Samuel   O.    L.  Potter,  A.M.,  M.D.,  M.R. 

C.P.  (London),  San  Francisco. 
Walter  L.  Pyle,  A.M.,  M.D.,  Philadelphia. 

B.  Alexander  Randall,  A.M.,  M.D.,  Phila. 
Joseph  Ransohoff,  M.D.,  F.R.C.S.  (Eng.), 

Cincinnati. 

Jay  F.  Schamberg,  A.M.,  M.D.,  Phila. 

Nicholas  Senn,  M.D.,  LL.D.,  Chicago. 

Richard  Slee,  M.D.,  Swiftwater,  Pa. 

S.    E.    Solly,    M.D.,    M.R.C.S.,    Colorado- 
Springs,  Col. 

Edmond  Souchon,  M.D.,  New  Orleans. 

Ward  F.  Sprenkel,  M.D.,  Philadelphia. 

Charles  G.  Stockton,  M.D.,  Buffalo. 

John  Madison  Taylor,  A.M.,  M.D.,  Phila. 

William  S.  Thayer,  M.D.,  Baltimore. 

James  Thorington,  A.M.,  M.D.,  Phila. 

Martin  B.  Tinker,  M.D.,  Philadelphia. 

James  Tyson,  M.D.,  Philadelphia. 

J.  Hilton  Waterman,  M.D.,  New  York. 

H.  A.  West,  M.D.,  Galveston,  Texas. 

J.  William  White,  M.D.,  PH.D.,  Phila. 

Reynold  W.  Wilcox,  M.A.,  M.D.,  LL.D., 
New  York, 

George  Wilkins,  M.D.,  Montreal. 

DeForest  Willard,  M.D.,  Philadelphia. 

Alfred  C.  Wood,  M.D.,  Philadelphia. 

Horatio  C.  Wood,  M.D.,  LL.D.,  Phila. 

Albert  Woldert,  Ph.G.,  M.D.,  Phila. 

James  K.  Young,  M.D.,  Philadelphia. 


Deaver's  Surgical  Anatomy 

A  Treatise  on  Human  Anatomy 
in  its  Application  to  the  Practice 
of  Medicine  and  Surgery     J>     J- 

By  JOHN  B.  DEAVER,  M.D. 

Surgeon-in-Chief  to  the  German  Hospital,  Philadelphia  ;  Surgeon  to  the  Children's  Hospital; 

Consulting  Surgeon    to    St.  Agnes' ,  St.    Timothy's,    and   Germantown 

Hospitals :  formerly  Assistant  Professor  of  Applied 

Anatomy ,  University  of  Pennsylvania,  etc. 

In  Three  Royal  Octavo  Volumes,  containing  about  Four  Hundred  and  Fifty  Full-page  Plates, 
nearly  all  from  dissections  made  for  the  purpose 


Handsome  Cloth,  $21.00  ;    Full  Sheep,  $24.00  ;    Half  Green  Morocco, 
Marbled  Edges,  $24.00  ;  Half  Russia,  Qiit,  Marbled  Edges,  $27.00  net. 


SYNOPSIS  OF  CONTENTS 

VOLUME  L— Upper  Extremity— Back  of  Neck,  Shoulder,  and  Trunk— Cranium— Scalp- 
Face. 

VOLUME  IL— Neck— Mouth,  Pharynx,  Larynx,  Nose— Orbit— Eyeball— Organ  of  Hearing- 
Brain — Female  Perineum — Male  Perineum. 

VOLUME  m.— Abdominal  Wall— Abdominal  Cavity— Pelvic  Cavity— Chest— Lower  Ex- 
tremity. 

The  book  is  designed  to  aid  the  general  practitioner  and  surgeon  in  his 
everyday  work.  The  text  is  excellently  clear,  succinct,  and  systematically  arranged, 
and  contains  a  wealth  of  illustrations  far  in  advance  of  the  usual  text-book.  It  is  not 
intended  merely  for  the  surgeon — though  to  him  it  will  prove  invaluable — ^but  for  the 
general  physician,  who,  while  called  upon  to  cope  with  innumerable  emergencies  and 
special  cases,  has  not  the  means  or  the  hospital  facilities  by  which  he  can  readily 
acquaint  himself  with  every  phase  of  anatomy — superficial  and  deep — as  applied  to 
disease  and  the  most  modern  methods  of  treatment  of  injuries. 

To  the  specialist  it  will  prove  of  great  value.  The  anatomy  of  the  head' and 
neck,  the  spinal  cord,  the  organs  of  sense,  and  the  throat  appeals  directly  to  the 
ophthalmologist,  aurist,  rhinologist,  laryngologist,  and  neurologist,  while  those  sections 
devoted  to  the  abdomen  and  pelvic  cavity  will  give  the  gynecologist  and  specialist 
on  diseases  of  the  urinary  organs,  rectum,  etc.,  material  regarding  the  relations  of  the 
parts  and  the  operations  thereon,  unique  in  many  ways,  and  in  a  manner  never  before 
so  exactly  and  concisely  stated.  To  those  devoted  to  these  specialties  it  will  prove  a 
supplement  to  other  text-books  that  omit  special  anatomy,  and  which  do  not  attempt 
to  show  the  applied  anatomy. 

44 


Deaver's  Surgical  Anatomy 


The  illustrations,  which  at  the  first  glance  appear  as  the  prominent  feature  of 
the  book — but  which  in  reaUty  do  not  overshadow  the  text — consist  of  a  series  of 
pictures  absolutely  unique  and  fresh.  They  will  bear  comparison  from  an  artistic  point 
of  view  with  any  other  work,  while  from  a  practical  point  of  view  there  is  no  other 
volume  or  series  of  volumes  to  which  they  can  be  compared.  When  originally  an- 
nounced, the  book  was  to  contain  two  hundred  illustrations.  As  the  work  of  prepara- 
tion progressed,  this  number  gradually  increased  until  it  is  estimated  that  there  will  now 
be  more  than  four  hundred  full-page  plates,  many  of  which  contain  more  than  one 
figure.  With  the  exception  of  a  few  minor  pictures  made  from  preparations  in  the 
possession  of  the  author,  they  have  all  been  drawn  by  special  artists  from  dissections 
made  for  the  purpose  in  the  dissecting-rooms  of  the  University  of  Pennsylvania.  Their 
accuracy  cannot  be  questioned,  as  each  drawing  has  been  submitted  to  the  most  careful 
scrutiny. 

From  The  Medical  Record,  New  York, 

"  The  reader  is  not  only  taken  by  easy  and  natural  stages  from  the  more  superficial  to  the 
deeper  regions,  but  the  various  important  regional  landmarks  are  also  indicated  by  schematic 
tracing  upon  the  limbs.  Thus  the  courses  of  arteries,  veins,  aud  nerves  are  indicated  in  a  way  that 
makes  the  lesson  strikingly  impressive  and  easily  learned.  No  expense,  evidently,  has  been 
spared  in  the  preparation  of  the  work,  judging  from  the  number  of  full-page  plates  it  contains,  not 
counting  the  smaller  drawings.  Most  of  these  have  been  *  drawn  by  special  artists  from  dissections 
made  for  the  purpose  in  the  dissecting-rooms  of  the  University  of  Pennsylvania.'  In  summing  up 
the  general  excellences  of  this  remarkable  work,  we  can  accord  our  unqualified  praise  for  the 
accurate,  exhaustive,  and  systematic  manner  in  which  the  author  has  carried  out  his  plan,  and  we 
can  commend  it  as  a  model  of  its  kind,  which  must  be  possessed  to  be  appreciated.'^ 

From  The  Philadelphia  Medical  Journal. 

"  Many  members  of  the  profession  to  whom  Dr.  Deaver  is  well  known  either  personally  or  by 
reputation  as  a  surgeon,  writer,  teacher,  and  practical  anatomist,  have  awaited  the  appearance  of 
his  Surgical  Anatomy  with  the  expectation  of  finding  in  it  a  guide  in  this  difficult  branch  of  medi- 
cine of  much  more  than  ordinary  practical  value,  and  their  expectations  will  not  be  disappointed.** 

From  The  Journal  of  the  American  Medical  Association. 

"  In  order  to  show  its  thoroughness,  it  is  only  necessary  to  mention  that  no  less  than  twelve 
full-page  plates  are  reproduced  in  order  to  accurately  portray  the  surgical  anatomy  of  the  hand, 
and  it  is  doubtful  whether  any  better  description'exists  in  any  work  in  the  English  language." 

From  The  Southern  California  Practitioner. 

"  Aside  from  the  merit  of  this  great  work,  it  will  be  a  delight  to  the  lover  of  books.  Its  gen 
eral  make-up  shows  the  highest  development  of  the  book-making  art.  The  bibliophile,  when 
holding  one  of  these  volumes  in  his  hands,  would  be  as  careful  with  it  as  though  he  were  handling 
an  infant,  and  to  drop  it  would  cause  him  the  keenest  pain.  The  illustrations,  the  print,  and  the 
paper  and  binding  are  each  and  all  delightful  in  themselves,  and  yet  the  text  is  concise  and  clear, 
and  taken  with  the  illustrations  make  a  remarkably  good  substitute  for  the  dissecting-room.  To 
have  these  three  volumes  on  his  library  shelves  will  be  a  source  of  pride  and  joy  and  profit  to 
every  practitioner.  Dr.  Deaver  has  in  these  volumes  conferred  a  boon  upon  the  medical  profession 
which  has,  at  least,  never  been  surpassed  by  any  one." 

From  The  New  Orleans  Medical  and  Surgical  Journal, 

"  While  the  needs  of  the  undergraduate  have  been  fully  kept  in  view,  it  has  been  the  aim  of 
the  author  to  provide  a  work  which  would  be  sufficient  for  reference  for  use  in  actual  practice.  We 
believe  the  book  fulfils  both  requirements.  The  arrangement  is  systematic  and  the  discussion  of 
surgical  relations  thorough.** 

S^^  Large  Descriptive  Circular  will  be  sent  upon  application 

45 


Hemmeter*     Diseases  of  the  Stomach*     Second 
Edition^  Enlarged*     Illustrated* 

Their  Special  Pathology,  Diagnosis,  and  Treatment.  With  Sections  on  Anatomy, 
Analysis  of  Stomach  Contents,  Dietetics,  Surgery  of  the  Stomach,  etc.  By  John 
C.  Hemmeter,  M.D.,  PHILOS.D.,  Professor  in  the  Medical  Department  of  the 
University  of  Maryland  ;  Consultant  to  the  University  Hospital ;  Director  of  the 
Clinical  Laboratory,  etc.  Second  Revised  Edition.  With  Colored  and  other 
Illustrations.     Octavo.      890  pages. 

Cloth,  $6.00;    Leather,  ^7.00;    Half  Russia,  $8.00 

*^*  The  rapid  sale  of  the  first  edition  of  this  book  has  encouraged  the  author  to 
revise  it  very  thoroughly  and  to  add  much  new  material  (about  100  pages)  and  a  num- 
ber of  new  illustrations.  About  two-thirds  of  the  book  has  been  actually  reconstructed. 
The  section  on  Dietetics  will  be  found  particularly  useful. 

"  A  second  enlarged  and  revised  edition  appearing  in  a  little  over  a  year  from  the  date  of  the 
original  publication  speaks  for  the  popularity  and  value  of  the  work.  This  book  easily  occupies 
the  first  place  among  its  sort  in  the  English  language  and  is  particularly  free  from  that  enthusiastic 
hobby  riding  which  is  not  unknown  among  gastro-enterologists.  The  bibliographical  references 
are  very  full  and  complete,  and  the  work  is  one  of  the  highest  order  as  well  as  one  of  the  utmost 
practical  value." — Chicago  Medical  Recorder. 

"  This  edition  of  Hemmeter's  work  on  '  Diseases  of  the  Stomach '  contains  much  new  and 
important  material.  The  following  articles  have  been  added  :  Hypertrophic  stenosis  of  the  pylorus, 
obstruction  of  the  orifices,  the  use  and  abuse  of  rest  and  exercise  in  the  treatment  of  digestive  dis- 
eases. Part  of  the  chapter  on  motor  insufficiency,  electro-diaphany,  hemorrhage  from  the  stomach, 
and  the  articles  on  gastroptosis  and  enteroptosis  have  been  entirely  rewritten.  The  present  edition 
will  undoubtedly  gain  as  many  friends  as  the  first  edition." — The  Medical  Record,  New  York. 

"  Dr.  Hemmeter  certainly  provides  a  book  which  is  well  worthy  of  a  careful  study.  ...  It 
treats  of  many  subjects  in  an  original  manner,  and  is  not  only  based  on  a  considerable  personal 
experience,  but  takes  due  notice  of  the  labors  of  other  well-known  workers  in  this  field." — British 
Medical  Journal. 

"  Completely  scientific,  modern,  accurate,  and  creditable.  .  .  .  We  commend  it." — Journal 
of  the  American  Medical  Association. 

"We  know  of  no  work  from  which  the  physician  may  gain  more  information  than  this." — 
Australian  Medical  Gazette. 

"  The  consideration  of  the  general  methods  of  clinical  examination  of  the  stomach  is  thor- 
oughly adequate." — Boston  Medical  and  Surgical  Journal. 

"  We  part  from  Dr.  Hemmeter's  book  with  the  sense  that  it  embodies  the  best  knowledge  of 
the  time." — London  Lancet. 

"  We  wish  to  express  unqualified  approval  of  the  tendency  which  is  shown  to  emphasize  the 
simple  and  more  practical  methods  of  diagnosis." — New  York  Medical  Journal. 

"  The  best  contemporary  treatise  on  diseases  of  the  stomach  which  we  possess,  not  only  in 
America,  but  in  the  whole  world." — Rro/.  I.  Boas,  of  Berlin. 


In  Preparation  by  the  same  Author 

Diseases  of  the  Intestines*    Original  Illustrations 

A  Complete,  Systematic  Treatise,  Including  the  Surgical  Aspects  of  the  Subject 

46 


Gordinier*  The  Gross  and  Minute  Anatomy 
of  the  Central  Nervous  System*  Colored 
Illustrations* 

By  H.  C.  GoRDiNiER,  A.M.,  M.D.,  Professor  of  Physiology  and  of  the  Anatomy 
of  the  Nervous  System  in  the  Albany  Medical  College  ;  Member  American  Neuro- 
logical Association.  With  48  Full-page  Plates  and  213  other  Illustrations,  a 
number  of  which  are  printed  in  Colors  and  many  of  which  are  original.  Large 
8vo.  Cloth,  f6.oo  ;  Sheep,  $7.00  ;  Half  Russia,  $8.00. 

*^*  It  is  universally  acknowledged  that  for  a  proper  comprehension  of  the  normal 
and  abnormal  activities  of  an  organ  a  thorough  knowledge  of  its  anatomy  is  absolutely 
essential.  This  is  particularly  true  of  diseases  of  the  central  nervous  system,  for  in  no 
other  way  can  the  disease  symptoms  be  explained.  Without  this  knowledge,  clinical 
and  pathologic  observations  are  of  little  avail.  This  book  is  not  a  theoretic  and  tech- 
nical student's  book,  but  a. useful  working  supplement  to  all  works  upon  general  practice 
and  neurology,  and  as  such  is  destined  to  mark  an  epoch  in  medical  literature. 

*'  This  is  an  excellent  book  on  a  fascinating  subject,  and  the  author  deserves  the  thanks  of  the 
English-speaking  medical  world  for  his  labor  in  getting  it  up.  There  are  works  enough  on  general 
anatomy,  and  dry  enough  they  are,  as  we  all  remember  only  too  well ;  but  the  anatomy  of  the 
nervous  system  alone  is  another  matter  entireiy,  for  it  is  one  of  the  most  interesting  of  all  subjects 
of  medical  study,  at  the  same  time  that  it  is  one  of  the  most  difficult.  For  both  of  these  reasons 
the  subject  is  deserving  of  a  treatise  by  itself,  and  should  not  be  briefly  discussed  in  a  few  pages 
of  a  general  work  on  anatomy,  or  in  an  introductory  chapter  of  a  treatise  on  diseases  of  the  ner- 
vous system." — Medical  Record,  New  York, 

"  The  author  has  made  an  honest  attempt  to  place  in  the  hands  of  the  English  student  a 
comprehensive  and  accurate  text-book,  devoid  of  the  many  intricacies  of  modern  thought  and 
speculation.  For  the  average  man  the  work  will  appeal  strongly ;  the  facts  that  he  can  use  are 
readily  found." — The  Journal  of  Ne7~vous  and  Mental  Diseases,  New  York. 

"  Throughout  the  book  the  descriptions  of  the  gross  and  minute  anatomy  are,  as  a  rule,  clear, 
objective,  and  as  easy  of  comprehension  as  could  be  expected  of  so  difficult  a  subject.  The  state- 
ments are  most  of  them  quite  didactically  made,  but  this  we  consider  an  advantage  rather  than  a 
defect,  especially  in  a  text-book  for  students  as  well  as  practitioners.  .  .  .  The  chapter  on 
cerebral  localization  is  carefully  written,  and  gives  the  most  recent  results  on  the  subject." — The 
American  Journal  of  Insanity,  Baltimore. 

"  Represents  much  painstaking  research,  and  bears  also  the  stamp  of  original  investigation. 
It  is  unusually  well  written,  and  the  illustrations,  many  of  which  are  original,  are  well  chosen.  It 
is  destined  to  take  its  place  among  the  standard  books  of  its  class." — New  York  Medical  Journal. 

"  This  book  will  be  welcomed  by  teachers,  practitioners,  and  students.  It  will  save  teachers 
and  writers  on  the  nervous  system  the  necessity  of  accompanying  their  lectures  and  books  on 
diseases  of  the  nervous  system  with  chapters  on  anatomy.  It  is  really  the  first  thoroughly  system- 
atic work  on  the  anatomy  of  the  central  nervous  system  that  has  appeared  in  the  English  language. 
The  work  is  the  more  necessary  because  diseases  of  the  central  nervous  system  are  becoming  more 
and  more  recognized,  and  because  the  works  on  general  anatomy  do  not  pretend  to  describe  the 
minute  anatomy  of  the  central  nervous  system.  Authors  of  books  on  neurology  recognize  the  fact 
that  their  readers  cannot  understand  the  descriptions  of  the  diseases  of  the  central  nervous  system 
without  a  knowledge  of  the  anatomy  of  the  parts  involved.  The  subject  is  a  difficult  one  at  best, 
but  the  student  who  will  make  an  earnest  effort  to  master  the  details  cannot  fail  to  do  so  with  the 
aid  of  this  work.  The  author's  descriptions  are  clear,  concise,  comprehensive,  and  profusely  and 
beautifully  illustrated." — Pacific  Medical  Journal,  San  Francisco. 

"  As  there  can  be  no  accurate  understanding  of  the  diseases  of  the  nervous  system  without  a 
thorough  knowledge  of  the  anatomy,  it  is  no  wonder  that  the  average  practitioner  is  as  ignorant  of 
neurology  as  is  unfortunately  the  case.  The  present  volume  is  a  praiseworthy  attempt  to  remove 
the  approach  that  has  thus  far  rested  upon  English  and  American  neurology." — Boston  Medical 
and  Surgical  Journal. 

"  We  commend  Gordinier's  chapter  on  cerebral  localization.  This  will  be  especially  helpful  to 
clinicians,  although  all  the  views  expressed  in  it  are  not  yet  outside  of  the  domain  of  controversy. 
We  should  like  to  say  more  about  Gordinier's  book,  but  space  forbids.  It  is  handsomely  printed 
and  copiously  illustrated,  and  we  can  recommend  it  as  a  good  text-book  of  nervous  anatomy." 
— Philadelphia  Medical  Journal. 

47 


JUST  READY 

PRACTICAL  GYNECOLOGY 

A  Modern  Comprehensive  Text-Book 
By  E.  E.  MONTGOMERY,  M.D. 

Professor  of  Gynecology,  Jefferson  Medical  College?   Gynecologist  to  the  Jefferson  Medical 

College  and  St.  Joseph's  Hospitals ;   Consulting  Gynecologist  to 

the  Philadelphia  Lying-in  Charity 

WITH  FIVE  HUNDRED  AND  TWENTY-SEVEN 
ILLUSTRATIONS 

Nearly  all  of  which  have  been  Drawn  and  Engraved  Specially  for  this 
"Work,  for  ttie  most  part  ftom  Original  Sources 

OCTAVO.    819  PAGES 
CLOTH,  $5.00;   LEATHER,  $6.00  j  HALF  RUSSIA,  $7.00 


EXTRACT  FROM  THE  PREFACE 

This  work  has  been  under  consideration  for  the  past  fifteen  years,  and  much  of  it 
has  been  several  times  rewritten.  An  effort  has  been  made  to  make  it  a  comprehensive 
work  upon  the  subject,  giving  the  experience  and  methods  of  the  most  careful  men, 
while  my  own  experience  has  been  utilized  to  indicate  that  which  I  have  found  most 
useful  and  worthy  of  acceptance. 

Each  general  subject  is  considered  with  reference  to  its  influence  upon  the  entire 
genital  tract,  and  the  work  is  divided  into  sections  rather  than  chapters.  This  course, 
although  a  departure  from  the  ordinary  text-book  arrangement,  is  that  which  experience 
has  demonstrated  to  be  most  effective  in  impressing  the  subject  upon  the  student,  and 
would  seem  to  me  preferable  to  him  who  uses  the  book  to  refresh  his  knowledge  upon 
some  particular  subject.  The  illustrations  are  arranged  solely  with  the  purpose  of 
rendering  clear  the  text  and  to  promote  the  work  of  diagnosis  and  treatment.  For  the 
excellence  and  character  of  the  illustrations  I  am  greatly  indebted  to  the  generosity  of 
the  publishers  and  to  the  skill  and  patience  of  their  artists,  Messrs.  Shannon  and  Von 
du  Lancken.  To  the  kindly  oversight  of  Dr.  Robert  L.  Dickinson  is  due  much  of  the 
exactness  of  the  drawings.  Acknowledgment  is  due  Miss  Eleanor  A.  Cantner  for  her 
ability  in  the  preparation  of  preliminarj^  sketches  and  of  the  index. 

Should  it  be  the  means  of  lightening  the  work  of  the  student,  of  making  more 
clear  the  pathway  of  the  busy  practitioner,  and,  most  of  all,  of  benefiting  suffering 
women  through  improved  methods  of  diagnosis  and  treatment,  I  shall  feel  well  repaid 
for  the  many  days  and  nights  of  labor  which  it  has  cost. 

48 


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